MEDICARE: MR. ROBERT F 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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1972801959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT F HERNANDEZ

Provider Business Mailing Address
First Line	:	3185 W 3650 S APT A
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84119-4311
Country	:	US
Telephone Number	:	801-828-6386
Fax Number	:

Provider Business Practice Location Address
First Line	:	3185 W 3650 S APT A
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84119-4311
Country	:	US
Telephone Number	:	801-828-6386
Fax Number	:

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

Provider Enumeration Date	:	03/01/2011
Last Update Date	:	03/01/2011

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Directions to “ MR. ROBERT F HERNANDEZ ” Practice Location

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