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General NPI Number Information
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NPI Number | 1467720946
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Entity Type | Individual
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Provider Name | RAUL HERNANDEZ I
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Gender | Male
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Dates
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Enumeration Date | 12/12/2011
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Last Update Date | 12/12/2011
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Provider Practice Location Address
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Address Line | 3785 NW 82ND AVE STE 109 3785 NW 82 AVE STE 109
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City | DORAL
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State | FL
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Zip | 33166-6629
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Country | US
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Telephone | 305-468-9373
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Fax | 305-468-9374
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Provider Business Mailing Address
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Address Line | 3785 NW 82ND AVE STE 109
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City | DORAL
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State | FL
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Zip | 33166-6629
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Country | US
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Telephone | 305-468-9373
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Fax | 305-468-9374
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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 | MA 62303
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License Number State | FL
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