Individual
ILDEFONSO HERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
14411 COMMERCE WAY, MIAMI LAKES, FL 33016-1596
(305) 625-8844
Mailing address
640 NE 1ST PL, HIALEAH, FL 33010-5044
(786) 343-0773
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
26504
FL
Other
Enumeration date
10/25/2017
Last updated
10/25/2017
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