Provider Demographics
NPI:1447636345
Name:HERNANDEZ, BOBBY RAY (RN)
Entity type:Individual
Prefix:
First Name:BOBBY
Middle Name:RAY
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 MORNING BROOK WAY
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-2118
Mailing Address - Country:US
Mailing Address - Phone:832-434-1444
Mailing Address - Fax:
Practice Address - Street 1:2811 MORNING BROOK WAY
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-2118
Practice Address - Country:US
Practice Address - Phone:832-434-1444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX807464163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant