Provider Demographics
NPI:1013553106
Name:HERNANDEZ, RALPH (LMT)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 WYNNTRY DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-3352
Mailing Address - Country:US
Mailing Address - Phone:773-715-7119
Mailing Address - Fax:
Practice Address - Street 1:2800 W SAHARA AVE STE 8B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-4381
Practice Address - Country:US
Practice Address - Phone:702-703-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-23
Last Update Date:2019-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9759225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist