Healthcare Provider Details

I. General information

NPI: 1982938551
Provider Name (Legal Business Name): CORI HERNANDEZ LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 09/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 KEENE RD
RICHLAND WA
99352
US

IV. Provider business mailing address

134 KEENE RD
RICHLAND WA
99352
US

V. Phone/Fax

Practice location:
  • Phone: 509-628-9966
  • Fax: 509-628-9976
Mailing address:
  • Phone: 509-628-9966
  • Fax: 509-628-9976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60058616
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: