Provider Demographics
NPI:1689914814
Name:HERNANDEZ LORA, RAFAEL OSVALDO (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:OSVALDO
Last Name:HERNANDEZ LORA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8529 PINES BLVD
Mailing Address - Street 2:CHEN MEDICAL PEMBROKE PINES, INC
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024
Mailing Address - Country:US
Mailing Address - Phone:954-704-3300
Mailing Address - Fax:954-800-2071
Practice Address - Street 1:2200 N COMMERCE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3258
Practice Address - Country:US
Practice Address - Phone:305-898-9707
Practice Address - Fax:954-529-2001
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-25
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME119903207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program