Provider Demographics
NPI:1821684788
Name:HINOJOSA, TOMAS III (LAB DIRECTOR)
Entity Type:Individual
Prefix:MR
First Name:TOMAS
Middle Name:
Last Name:HINOJOSA
Suffix:III
Gender:M
Credentials:LAB DIRECTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 180662
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-0662
Mailing Address - Country:US
Mailing Address - Phone:972-799-7769
Mailing Address - Fax:
Practice Address - Street 1:1505 TAVISTOCK RD
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-0750
Practice Address - Country:US
Practice Address - Phone:972-799-7769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX861664163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator