Provider Demographics
NPI:1912548512
Name:HERNANDEZ, MARIO ALONSO (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:ALONSO
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 HUDSPETH ST
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:TX
Mailing Address - Zip Code:76950-8003
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 HUDSPETH ST
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:TX
Practice Address - Zip Code:76950-8004
Practice Address - Country:US
Practice Address - Phone:325-374-0883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143348363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily