Provider Demographics
NPI:1184624892
Name:HERNAEZ, IRENE (DPM)
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:
Last Name:HERNAEZ
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:IRENE
Other - Middle Name:
Other - Last Name:HERNAEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 16903
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77496-6903
Mailing Address - Country:US
Mailing Address - Phone:281-937-0077
Mailing Address - Fax:877-231-0556
Practice Address - Street 1:16659 SOUTHWEST FWY
Practice Address - Street 2:SUITE 201
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2375
Practice Address - Country:US
Practice Address - Phone:281-937-0077
Practice Address - Fax:877-231-0556
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1382213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7620022OtherAETNA
TX42627OtherAMERIGROUP
TX0071CTOtherBCBS
TX092739402Medicaid
TX7620022OtherAETNA
TX0071CTOtherBCBS
TX42627OtherAMERIGROUP
TXU71122Medicare UPIN