Provider Demographics
NPI:1659550457
Name:HERNANDEZ, ROXANNE CELINA
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:CELINA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 REMCON CIR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-1642
Mailing Address - Country:US
Mailing Address - Phone:915-842-1788
Mailing Address - Fax:
Practice Address - Street 1:7300 REMCON CIR
Practice Address - Street 2:SUITE 300
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-1642
Practice Address - Country:US
Practice Address - Phone:915-842-1788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33995235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist