Provider Demographics
NPI:1700569340
Name:GARCIA HERNANDEZ, RAUL JESUS
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:JESUS
Last Name:GARCIA 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 1:2565 W 56TH ST APT 109
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-4707
Mailing Address - Country:US
Mailing Address - Phone:786-757-3520
Mailing Address - Fax:
Practice Address - Street 1:2565 W 56TH ST APT 109
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-4707
Practice Address - Country:US
Practice Address - Phone:786-757-3520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator