Provider Demographics
NPI:1730870098
Name:HERNANDEZ CASTRO, DUMAY (SA-C)
Entity type:Individual
Prefix:
First Name:DUMAY
Middle Name:
Last Name:HERNANDEZ CASTRO
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 LOMOND DR
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33953-4529
Mailing Address - Country:US
Mailing Address - Phone:469-374-1141
Mailing Address - Fax:
Practice Address - Street 1:260 LOMOND DR
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33953-4529
Practice Address - Country:US
Practice Address - Phone:469-374-1141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23380246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant