Basic Information
| Provider Information | |||||||||
| NPI: | 1689914814 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERNANDEZ LORA | ||||||||
| FirstName: | RAFAEL | ||||||||
| MiddleName: | OSVALDO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8529 PINES BLVD | ||||||||
| Address2: | CHEN MEDICAL PEMBROKE PINES, INC | ||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547043300 | ||||||||
| FaxNumber: | 9548002071 | ||||||||
| Practice Location | |||||||||
| Address1: | 2200 N COMMERCE PKWY STE 200 | ||||||||
| Address2: | |||||||||
| City: | WESTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333263258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058989707 | ||||||||
| FaxNumber: | 9545292001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2013 | ||||||||
| LastUpdateDate: | 09/22/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | ME119903 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.