Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 9759 | NV |
NPI | 1013553106 |
---|---|
Provider Name | Ralph Hernandez |
First Address | Henderson, NV 89074-3352 |
Second Address | Las Vegas, NV 89102-4381 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2019 |
Last Update Date | 23/11/2019 |