Provider Demographics
NPI:1891417127
Name:HERNANDEZ, RACHEL BALDERRAMA (SLPA)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:BALDERRAMA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 IRWIN DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78222-1323
Mailing Address - Country:US
Mailing Address - Phone:210-848-3808
Mailing Address - Fax:
Practice Address - Street 1:2515 IRWIN DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78222-1323
Practice Address - Country:US
Practice Address - Phone:210-848-3808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX235Z00000XMedicaid