MEDICARE: JAVIER ALBERTO 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	343900000X	Non-emergency Medical Transport (VAN)		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	:	1629606116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAVIER ALBERTO HERNANDEZ

Provider Business Mailing Address
First Line	:	11201 NW 89TH ST APT 109
Second Line	:
City	:	DORAL
State	:	FL
Zip	:	33178-2366
Country	:	US
Telephone Number	:	786-445-2024
Fax Number	:

Provider Business Practice Location Address
First Line	:	1640 BORO PL
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22102-3612
Country	:	US
Telephone Number	:	804-585-6909
Fax Number	:

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

Provider Enumeration Date	:	03/30/2020
Last Update Date	:	08/27/2020

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