Provider Demographics
NPI:1720498611
Name:HERNANDEZ, ANTHONY (AUD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 WASHINGTON AVE S
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3405
Mailing Address - Country:US
Mailing Address - Phone:800-328-8602
Mailing Address - Fax:
Practice Address - Street 1:4032 S LAMAR BLVD
Practice Address - Street 2:SUITE 450
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-8803
Practice Address - Country:US
Practice Address - Phone:512-416-6600
Practice Address - Fax:512-416-6604
Is Sole Proprietor?:No
Enumeration Date:2014-05-01
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX237700000X
TX80651237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX540622ZWGXOtherMEDICARE