| Doctor Name: | ROY HERNANDEZ |
| NPI Number: | 1710025028 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 2693 |
| Business Practice Address: | 325 North Bergin Lane Bloomfield, NM - 87413 |
| Business Phone Number: | 5056324300 |
| Business Fax Number: | |
| Mailing Address: | 1230 La Loma Road, ANTON CHICO |
| State: | NM |
| Postal Code: | 877119501 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 02/01/2007 |
| NPI Last Update Date: | 08/13/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 2693 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |