Provider Demographics
NPI:1700501152
Name:HERNANDEZ, JAVIER (RD)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 PLANTAIN LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-6234
Mailing Address - Country:US
Mailing Address - Phone:713-518-2047
Mailing Address - Fax:
Practice Address - Street 1:1214 N POST OAK RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-7271
Practice Address - Country:US
Practice Address - Phone:512-548-0465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-07
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT86989133V00000X
TX86099454133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty