Healthcare Provider Details

I. General information

NPI: 1982152708
Provider Name (Legal Business Name): MERCEDES HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2016
Last Update Date: 09/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3414 W 84TH ST STE 110
HIALEAH FL
33018-4932
US

IV. Provider business mailing address

3414 W 84TH ST STE 110
HIALEAH FL
33018-4932
US

V. Phone/Fax

Practice location:
  • Phone: 786-970-4884
  • Fax:
Mailing address:
  • Phone: 786-970-4884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: