Provider Demographics
NPI:1982713236
Name:CORPUS CHRISTI NEUROLOGY
Entity Type:Organization
Organization Name:CORPUS CHRISTI NEUROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-853-0867
Mailing Address - Street 1:3301 S ALAMEDA ST STE 501
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-1871
Mailing Address - Country:US
Mailing Address - Phone:361-853-0867
Mailing Address - Fax:361-853-0887
Practice Address - Street 1:3301 S ALAMEDA ST STE 501
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1871
Practice Address - Country:US
Practice Address - Phone:361-853-0867
Practice Address - Fax:361-853-0887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00885KMedicare ID - Type Unspecified