MEDICARE: RAFAEL HERNANDEZ AVILA

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	MA93695	FL

General Provider Information

NPI Number	:	1699412742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAFAEL HERNANDEZ AVILA

Provider Business Mailing Address
First Line	:	5220 LAKE UNDERHILL RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32807-1657
Country	:	US
Telephone Number	:	407-947-0531
Fax Number	:

Provider Business Practice Location Address
First Line	:	5220 LAKE UNDERHILL RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32807-1657
Country	:	US
Telephone Number	:	407-947-0531
Fax Number	:

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

Provider Enumeration Date	:	05/18/2022
Last Update Date	:	05/18/2022

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Directions to “ RAFAEL HERNANDEZ AVILA ” Practice Location

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