Healthcare Provider Details

I. General information

NPI: 1003732801
Provider Name (Legal Business Name): KENDALL SOUTH FOUNDATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4689 PONCE DE LEON BLVD STE 200
CORAL GABLES FL
33146-2133
US

IV. Provider business mailing address

4689 PONCE DE LEON BLVD STE 200
CORAL GABLES FL
33146-2133
US

V. Phone/Fax

Practice location:
  • Phone: 786-234-0513
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: LUIS O HERNANDEZ
Title or Position: VICE PRESIDENT
Credential:
Phone: 786-234-0513