Healthcare Provider Details

I. General information

NPI: 1033864939
Provider Name (Legal Business Name): DAVID HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2022
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 W 68TH ST STE 403
HIALEAH FL
33016-1815
US

IV. Provider business mailing address

7800 NW 25TH ST
DORAL FL
33122-1625
US

V. Phone/Fax

Practice location:
  • Phone: 305-987-3058
  • Fax:
Mailing address:
  • Phone: 305-593-2174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT21130
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: