Healthcare Provider Details

I. General information

NPI: 1558273870
Provider Name (Legal Business Name): RAMON HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 HAZELWOOD AVE S
LEHIGH ACRES FL
33936-5803
US

IV. Provider business mailing address

315 HAZELWOOD AVE S
LEHIGH ACRES FL
33936-5803
US

V. Phone/Fax

Practice location:
  • Phone: 239-791-1866
  • Fax: 239-790-3734
Mailing address:
  • Phone: 239-791-1866
  • Fax: 239-790-3734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA14746
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: