Healthcare Provider Details

I. General information

NPI: 1962570309
Provider Name (Legal Business Name): VIVIAN P HERNANDEZ-TRUJILLO M.D.,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16371 NW 67TH AVE
MIAMI LAKES FL
33014-6044
US

IV. Provider business mailing address

16371 NW 67TH AVE
MIAMI LAKES FL
33014-6044
US

V. Phone/Fax

Practice location:
  • Phone: 786-646-9280
  • Fax:
Mailing address:
  • Phone: 786-646-9280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License NumberME86606
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberME86608
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: