Provider Demographics
NPI:1659990794
Name:HERNANDEZ, ROSIMAR (RDT-BCT, LCAT, LPC)
Entity Type:Individual
Prefix:
First Name:ROSIMAR
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:RDT-BCT, LCAT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 S MARION AVE.
Mailing Address - Street 2:(117C)
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-5808
Mailing Address - Country:US
Mailing Address - Phone:646-753-2202
Mailing Address - Fax:
Practice Address - Street 1:619 S MARION AVE # 117C
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-5808
Practice Address - Country:US
Practice Address - Phone:646-753-2202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-09
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001221-1