MEDICARE: DR. RAQUEL G. HERNANDEZ M.D, MPH

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	208000000X	Pediatrics Physician	ME105045	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
2	146FP	OTHER	FL	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861538803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAQUEL G. HERNANDEZ M.D, MPH

Provider Business Mailing Address
First Line	:	4117 W KENSINGTON AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-8534
Country	:	US
Telephone Number	:	813-495-2778
Fax Number	:	727-767-8804

Provider Business Practice Location Address
First Line	:	4117 W KENSINGTON AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-8534
Country	:	US
Telephone Number	:	813-495-2778
Fax Number	:	727-767-8804

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	03/25/2014

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