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General NPI Number Information
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NPI Number | 1013553106
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Entity Type | Individual
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Provider Name | RALPH HERNANDEZ LMT
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Gender | Male
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Dates
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Enumeration Date | 11/23/2019
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Last Update Date | 11/23/2019
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Provider Practice Location Address
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Address Line | 2800 W SAHARA AVE STE 8B
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City | LAS VEGAS
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State | NV
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Zip | 89102-4381
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Country | US
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Telephone | 702-703-1800
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Fax |
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Provider Business Mailing Address
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Address Line | 131 WYNNTRY DR
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City | HENDERSON
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State | NV
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Zip | 89074-3352
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Country | US
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Telephone | 773-715-7119
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 9759
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License Number State | NV
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