Healthcare Provider Details

I. General information

NPI: 1497823454
Provider Name (Legal Business Name): PEDRO HERNANDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3090 S DOUGLAS RD
MIAMI FL
33133-4311
US

IV. Provider business mailing address

3090 S DOUGLAS RD
MIAMI FL
33133-4311
US

V. Phone/Fax

Practice location:
  • Phone: 305-351-1320
  • Fax: 305-444-7866
Mailing address:
  • Phone: 305-351-1320
  • Fax: 305-444-7866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberME19887
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: