Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | ARNP9321219 | FL |
NPI | 1003262825 |
---|---|
Provider Name | Raimundo Hernandez Zas |
First Address | Lake Worth, FL 33463-2252 |
Second Address | Lake Worth, FL 33463-2252 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2016 |
Last Update Date | 11/05/2016 |