Individual
IZAIC JOHN HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AR.LOPP,TX.LPOA
Contact information
Practice address
540 MADISON OAK DR STE 270, SAN ANTONIO, TX 78258-3930
(210) 495-3399
(210) 495-3393
Mailing address
16543 CRESTED BUTTE ST, SAN ANTONIO, TX 78247-1503
(210) 264-9037
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
0056
—
1744P3200X
Prosthetics Case Management
00075
—
222Z00000X
Orthotist
00083
AR
224P00000X
Prosthetist
Primary
00083
AR
225000000X
Orthotic Fitter
334
TX
Other
Enumeration date
01/31/2007
Last updated
02/05/2008
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