Healthcare Provider Details

I. General information

NPI: 1861538803
Provider Name (Legal Business Name): RAQUEL G. HERNANDEZ M.D, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 03/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4117 W KENSINGTON AVE
TAMPA FL
33629-8534
US

IV. Provider business mailing address

4117 W KENSINGTON AVE
TAMPA FL
33629-8534
US

V. Phone/Fax

Practice location:
  • Phone: 813-495-2778
  • Fax: 727-767-8804
Mailing address:
  • Phone: 813-495-2778
  • Fax: 727-767-8804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME105045
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: