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General NPI Number Information
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NPI Number | 1124510508
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Entity Type | Individual
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Provider Name | ROSA HERNANDEZ
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Gender | Female
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Dates
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Enumeration Date | 06/01/2018
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Last Update Date | 09/14/2021
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Provider Practice Location Address
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Address Line | 4280 BEE RIDGE RD
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City | SARASOTA
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State | FL
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Zip | 34233-2563
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Country | US
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Telephone | 941-363-6381
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Fax |
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Provider Business Mailing Address
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Address Line | 13801 TAMIAMI TRL STE B
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City | NORTH PORT
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State | FL
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Zip | 34287-2017
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Country | US
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Telephone | 941-200-5812
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN23380
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License Number State | FL
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