MEDICARE: JULIO J HERNANDEZ SOLE PROPRIETOR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver	H655430574590	FL

General Provider Information

NPI Number	:	1477309490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIO J HERNANDEZ SOLE PROPRIETOR

Provider Business Mailing Address
First Line	:	117 SHORE PKWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-6113
Country	:	US
Telephone Number	:	813-368-3612
Fax Number	:	866-432-6580

Provider Business Practice Location Address
First Line	:	117 SHORE PKWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33615-6113
Country	:	US
Telephone Number	:	813-368-3612
Fax Number	:	866-432-6580

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2024
Last Update Date	:	04/29/2024

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