MEDICARE: HECTOR HERNANDEZ BS

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	251B00000X	Case Management Agency
2	101YM0800X	Mental Health Counselor	IMH20178	FL

General Provider Information

NPI Number	:	1679829329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HECTOR HERNANDEZ BS

Provider Business Mailing Address
First Line	:	11438 SW 1ST ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33174-1032
Country	:	US
Telephone Number	:	786-718-5963
Fax Number	:

Provider Business Practice Location Address
First Line	:	11438 SW 1ST ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33174-1032
Country	:	US
Telephone Number	:	786-718-5963
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2012
Last Update Date	:	11/02/2022

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