MEDICARE: MR. RUBEN HERNANDEZ II ARRT (R)

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	261QR0206X	Mammography Clinic/Center	61478	FL
2	261QR0208X	Mobile Radiology Clinic/Center

General Provider Information

NPI Number	:	1407009566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RUBEN HERNANDEZ II ARRT (R)

Provider Business Mailing Address
First Line	:	387 W 29TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-5707
Country	:	US
Telephone Number	:	786-662-9177
Fax Number	:	305-381-5465

Provider Business Practice Location Address
First Line	:	387 W 29TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-5707
Country	:	US
Telephone Number	:	786-662-9177
Fax Number	:	305-381-5465

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

Provider Enumeration Date	:	11/02/2008
Last Update Date	:	11/02/2008

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