Provider Demographics
NPI:1689914814
Name:HERNANDEZ LORA, RAFAEL OSVALDO (MD)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:OSVALDO
Last Name:HERNANDEZ LORA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3161 SW 160TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4214
Mailing Address - Country:US
Mailing Address - Phone:954-450-3550
Mailing Address - Fax:954-450-3557
Practice Address - Street 1:3161 SW 160TH AVE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4214
Practice Address - Country:US
Practice Address - Phone:954-450-3550
Practice Address - Fax:954-450-3557
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-25
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME119903207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program