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General NPI Number Information
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NPI Number | 1114116050
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Entity Type | Organization
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Legal Business Name | DR MANNYS HAIR RESTORATION CENTER
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Dates
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Enumeration Date | 10/16/2007
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Last Update Date | 10/16/2007
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Provider Practice Location Address
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Address Line | 1255 VISCAYA PKWY # 1 103
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City | CAPE CORAL
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State | FL
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Zip | 33990-3290
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Country | US
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Telephone | 239-573-6111
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Fax | 239-573-9534
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Provider Business Mailing Address
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Address Line | 1255 VISCAYA PKWY # 1 103
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City | CAPE CORAL
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State | FL
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Zip | 33990-3290
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Country | US
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Telephone | 239-573-6111
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Fax | 239-573-9534
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Authorized Official
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Title or Position | PHYSICAN/OWNER
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Name | DR. MANNY J HERNANDEZ
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Credential | M.D.
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Telephone | 239-573-6111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME0041260
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License Number State | FL
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