Provider Demographics
NPI:1952728867
Name:HERNANDEZ, MARY VICTORIA (PA)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:VICTORIA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:VICTORIA
Other - Last Name:RANGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8610 MARTIN LUTHER KING BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77033-2308
Mailing Address - Country:US
Mailing Address - Phone:713-734-0199
Mailing Address - Fax:713-734-1564
Practice Address - Street 1:8610 MARTIN LUTHER KING BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77033-2308
Practice Address - Country:US
Practice Address - Phone:713-734-0199
Practice Address - Fax:713-734-1564
Is Sole Proprietor?:No
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09002363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant