Provider Demographics
NPI:1215932991
Name:HERNANDEZ, AQUILEO N (MD)
Entity type:Individual
Prefix:DR
First Name:AQUILEO
Middle Name:N
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 FM 1959 RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77034-5491
Mailing Address - Country:US
Mailing Address - Phone:281-922-5550
Mailing Address - Fax:
Practice Address - Street 1:11914 ASTORIA BLVD
Practice Address - Street 2:SUITE 570
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089
Practice Address - Country:US
Practice Address - Phone:281-481-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2010-07-01
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-06-27
Provider Licenses
StateLicense IDTaxonomies
TXG7822208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8J9473OtherMEDICARE
TX114880101Medicaid
TX114880101Medicaid