Provider Demographics
NPI:1104965334
Name:PLASENCIA, RAUL (NBC-HIS)
Entity type:Individual
Prefix:MR
First Name:RAUL
Middle Name:
Last Name:PLASENCIA
Suffix:
Gender:M
Credentials:NBC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7842 NW 197TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33015-6399
Mailing Address - Country:US
Mailing Address - Phone:305-491-6812
Mailing Address - Fax:305-816-8869
Practice Address - Street 1:7842 NW 197TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33015-6399
Practice Address - Country:US
Practice Address - Phone:305-491-6812
Practice Address - Fax:305-816-8869
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS2812237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist