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General NPI Number Information
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NPI Number | 1659426096
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Entity Type | Individual
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Provider Name | LUIS HERNANDEZ OPA-C
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Gender | Male
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2688 CEDARIDGE CIR
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City | CLERMONT
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State | FL
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Zip | 34711-7139
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Country | US
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Telephone | 407-654-4918
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Fax | 407-877-3634
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Provider Business Mailing Address
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Address Line | 2688 CEDARIDGE CIR
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City | CLERMONT
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State | FL
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Zip | 34711-7139
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Country | US
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Telephone | 407-654-4918
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Fax | 407-877-3634
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1008
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License Number State | FL
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