Provider Demographics
NPI:1386065548
Name:HERNANDEZ, MAURO
Entity type:Individual
Prefix:
First Name:MAURO
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N CAPITAL OF TEXAS HWY
Mailing Address - Street 2:BLDG. 6 SUITE 125
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-3302
Mailing Address - Country:US
Mailing Address - Phone:512-201-4042
Mailing Address - Fax:
Practice Address - Street 1:10001 S. 1ST ST
Practice Address - Street 2:APT. 918
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748
Practice Address - Country:US
Practice Address - Phone:917-916-1936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT041388225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist