Healthcare Provider Details

I. General information

NPI: 1598730210
Provider Name (Legal Business Name): GABRIEL HERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 10/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 S HARBOR CITY BLVD
MELBOURNE FL
32901-5594
US

IV. Provider business mailing address

2222 S HARBOR CITY BLVD SUITE 440
MELBOURNE FL
32901-5594
US

V. Phone/Fax

Practice location:
  • Phone: 321-725-5050
  • Fax: 321-722-2943
Mailing address:
  • Phone: 321-725-5050
  • Fax: 321-722-9243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME49471
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: