Provider Demographics
NPI:1356829469
Name:HERNANDEZ, LAWRENCE (LVN)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:LAWRENCE
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LVN
Mailing Address - Street 1:259 BASSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-2902
Mailing Address - Country:US
Mailing Address - Phone:210-430-4875
Mailing Address - Fax:
Practice Address - Street 1:259 BASSWOOD DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-2902
Practice Address - Country:US
Practice Address - Phone:210-430-4875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX173417164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse