Basic Information
Provider Information
NPI: 1003004805
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HERNANDEZ
FirstName: RAFAELA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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OtherCredential:  
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Mailing Information
Address1: 6055 E WASHINGTON BLVD
Address2:  
City: COMMERCE
State: CA
PostalCode: 900402418
CountryCode: US
TelephoneNumber: 3233460960
FaxNumber: 3233460966
Practice Location
Address1: 6055 E WASHINGTON BLVD
Address2: SUITE 900
City: LOS ANGELES
State: CA
PostalCode: 900402418
CountryCode: US
TelephoneNumber: 3233460960
FaxNumber: 3233460966
Other Information
ProviderEnumerationDate: 10/05/2007
LastUpdateDate: 10/05/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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AuthorizedOfficialTitleorPosition:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225400000X  Y Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner 

No ID Information.


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