Healthcare Provider Details

I. General information

NPI: 1174752265
Provider Name (Legal Business Name): VIVIAN HERNANDEZ M.D., F.A.C.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 07/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4799 NORTH FED HWY UNIT #4
BOCA RATON FL
33431
US

IV. Provider business mailing address

4799 NORTH FED HWY SUITE #2
BOCA RATON FL
33431
US

V. Phone/Fax

Practice location:
  • Phone: 561-750-8600
  • Fax: 541-750-8602
Mailing address:
  • Phone: 561-750-8600
  • Fax: 541-750-8602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME54911
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: