Provider Demographics
NPI:1861538803
Name:HERNANDEZ, RAQUEL G (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:RAQUEL
Middle Name:G
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4117 W KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-8534
Mailing Address - Country:US
Mailing Address - Phone:813-495-2778
Mailing Address - Fax:727-767-8804
Practice Address - Street 1:4117 W KENSINGTON AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-8534
Practice Address - Country:US
Practice Address - Phone:813-495-2778
Practice Address - Fax:727-767-8804
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105045208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001382500Medicaid
FL146FPOtherBLUE CROSS BLUE SHIELD
FL146FPOtherBLUE CROSS BLUE SHIELD