Provider Demographics
NPI:1801845318
Name:HERNANDEZ, AMBROSIO III (MD)
Entity Type:Individual
Prefix:
First Name:AMBROSIO
Middle Name:
Last Name:HERNANDEZ
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 E RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-5411
Mailing Address - Country:US
Mailing Address - Phone:956-688-1280
Mailing Address - Fax:956-688-1291
Practice Address - Street 1:1120 E RIDGE RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-5411
Practice Address - Country:US
Practice Address - Phone:956-688-1280
Practice Address - Fax:956-688-1291
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL99802086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172230802OtherCSHCN
TX172230801Medicaid
TX8P5610OtherBC/BS
TX172230802OtherCSHCN
TX172230801Medicaid