Organization
CLINICAL NEUROSCIENCE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERESA R HERNANDEZ (ADMINISTRATOR)
(817) 921-4191
Entity
Organization
Contact information
Practice address
1307 8TH AVE STE 608, FORT WORTH, TX 76104-4140
(817) 921-4191
(817) 926-6048
Mailing address
1307 8TH AVE STE 608, FORT WORTH, TX 76104-4109
(817) 921-4191
(817) 926-6048
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112880305
—
TX
05
—
112880306
—
TX
Enumeration date
03/01/2006
Last updated
05/15/2023
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