Healthcare Provider Details

I. General information

NPI: 1396790598
Provider Name (Legal Business Name): JORGE ADOLFO HERNANDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 PONCE DE LEON BLVD STE 228
CORAL GABLES FL
33134-2070
US

IV. Provider business mailing address

717 PONCE DE LEON BLVD STE 228
CORAL GABLES FL
33134-2070
US

V. Phone/Fax

Practice location:
  • Phone: 305-822-1993
  • Fax: 305-479-2745
Mailing address:
  • Phone: 305-665-2911
  • Fax: 305-479-2745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME94723
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: