Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | ME69249 | FL |
NPI | 1023167681 |
---|---|
Provider Name | Rafael Hernandez JR. |
First Address | Miami, FL 33145-2941 |
Second Address | Miami, FL 33145-2941 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 12/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
379517900 | (05) | FL |
G23698 | (02) | FL |