MEDICARE: ROBERTO HERNAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	77079	CA

General Provider Information

NPI Number	:	1003408410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTO HERNAL

Provider Business Mailing Address
First Line	:	9446 RALPH ST
Second Line	:
City	:	ROSEMEAD
State	:	CA
Zip	:	91770-2111
Country	:	US
Telephone Number	:	323-344-2337
Fax Number	:

Provider Business Practice Location Address
First Line	:	3756 W AVENUE 40 STE 2B
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90065-3667
Country	:	US
Telephone Number	:	323-344-2337
Fax Number	:	323-739-0094

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2021
Last Update Date	:	10/06/2021

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Directions to “ ROBERTO HERNAL ” Practice Location

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