MEDICARE: JESUS HERNANDEZ

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	235Z00000X	Speech-Language Pathologist	SA14239	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114356128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESUS HERNANDEZ

Provider Business Mailing Address
First Line	:	315 HAZELWOOD AVE S
Second Line	:
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33936-5803
Country	:	US
Telephone Number	:	239-791-1866
Fax Number	:	239-790-3734

Provider Business Practice Location Address
First Line	:	315 HAZELWOOD AVE S
Second Line	:
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33936-5803
Country	:	US
Telephone Number	:	135-168-0538
Fax Number	:

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

Provider Enumeration Date	:	11/11/2013
Last Update Date	:	05/19/2026

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Directions to “ JESUS HERNANDEZ ” Practice Location

Language	Start Address	Practice Location

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