Healthcare Provider Details

I. General information

NPI: 1720746530
Provider Name (Legal Business Name): INSULINIC OF HIALEAH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2021
Last Update Date: 06/24/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W 49TH ST STE 448
HIALEAH FL
33012-3487
US

IV. Provider business mailing address

220 JOHNSTON ST
LAFAYETTE LA
70501-8059
US

V. Phone/Fax

Practice location:
  • Phone: 305-385-3111
  • Fax: 305-364-7147
Mailing address:
  • Phone: 337-254-9999
  • Fax: 337-522-7543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HUMBERTO HERNANDEZ
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 305-385-3111