Provider Demographics
NPI:1952761249
Name:HERNANDEZ, JUAN
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:
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 1:13243 NW 4TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-1625
Mailing Address - Country:US
Mailing Address - Phone:786-387-0249
Mailing Address - Fax:
Practice Address - Street 1:8811 SW 132ND PL
Practice Address - Street 2:APT 309
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1792
Practice Address - Country:US
Practice Address - Phone:786-387-0249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA62921225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist