MEDICARE: HERNANDEZ MEDICAL CENTER CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	AHCA HCC6126	FL

General Provider Information

NPI Number	:	1114900875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HERNANDEZ MEDICAL CENTER CORP

Provider Business Mailing Address
First Line	:	2720 SW 97TH AVE
Second Line	:	# 101
City	:	MIAMI
State	:	FL
Zip	:	33165-2677
Country	:	US
Telephone Number	:	305-225-5652
Fax Number	:	305-225-5653

Provider Business Practice Location Address
First Line	:	2720 SW 97TH AVE
Second Line	:	# 101
City	:	MIAMI
State	:	FL
Zip	:	33165-2677
Country	:	US
Telephone Number	:	305-225-5652
Fax Number	:	305-225-5653

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ERIBERTO TORRES
Credential	:
Telephone Number	:	305-225-5652

Provider Enumeration Date	:	11/26/2005
Last Update Date	:	08/03/2011

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