Provider Demographics
NPI:1528646874
Name:PUCHE HERNANDEZ, EMIRO ALEJANDRO (SA-C)
Entity type:Individual
Prefix:
First Name:EMIRO
Middle Name:ALEJANDRO
Last Name:PUCHE HERNANDEZ
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3875 PONTE AVE APT 505
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4068
Mailing Address - Country:US
Mailing Address - Phone:214-909-0303
Mailing Address - Fax:
Practice Address - Street 1:3875 PONTE AVE APT 505
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-4068
Practice Address - Country:US
Practice Address - Phone:214-909-0303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20-326246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant