Provider Demographics
NPI:1649769381
Name:HERNANDEZ, RAUL ARMANDO (CAC I)
Entity Type:Individual
Prefix:MR
First Name:RAUL
Middle Name:ARMANDO
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:CAC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2831 15TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-4607
Mailing Address - Country:US
Mailing Address - Phone:202-462-4788
Mailing Address - Fax:202-640-1820
Practice Address - Street 1:2831 15TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-4607
Practice Address - Country:US
Practice Address - Phone:202-462-4788
Practice Address - Fax:202-640-1820
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCACI1038101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)