MEDICARE: JAIME HERNANDEZ LMT

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	MA60804408	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0383140	OTHER	WA	L & I

General Provider Information

NPI Number	:	1508360579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAIME HERNANDEZ LMT

Provider Business Mailing Address
First Line	:	414 W BAKERVIEW RD STE 110
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98226-8180
Country	:	US
Telephone Number	:	360-223-3696
Fax Number	:

Provider Business Practice Location Address
First Line	:	414 W BAKERVIEW RD STE 110
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98226-8180
Country	:	US
Telephone Number	:	360-223-3696
Fax Number	:	888-509-0108

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

Provider Enumeration Date	:	03/22/2018
Last Update Date	:	03/22/2018

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