Provider Demographics
NPI:1154428233
Name:HERNANDEZ, JASMINE S
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:S
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 N AVENUE H
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:TX
Mailing Address - Zip Code:77541-3460
Mailing Address - Country:US
Mailing Address - Phone:979-417-9270
Mailing Address - Fax:979-297-6226
Practice Address - Street 1:102 FLAG LAKE DR STE C
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-6215
Practice Address - Country:US
Practice Address - Phone:979-297-1201
Practice Address - Fax:979-297-6226
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant