Provider Demographics
NPI:1073096822
Name:HERNANDEZ, RAFAEL HERNANDO
Entity Type:Individual
Prefix:MR
First Name:RAFAEL
Middle Name:HERNANDO
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 NIGHTINGALE AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-3826
Mailing Address - Country:US
Mailing Address - Phone:305-965-4900
Mailing Address - Fax:
Practice Address - Street 1:999 NIGHTINGALE AVE
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-3826
Practice Address - Country:US
Practice Address - Phone:305-965-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA28715225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant