Healthcare Provider Details

I. General information

NPI: 1720263833
Provider Name (Legal Business Name): HERNAN R BAQUERIZO MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 04/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3661 S MIAMI AVE SUITE 505
MIAMI FL
33133-4200
US

IV. Provider business mailing address

3661 S MIAMI AVE SUITE 505
MIAMI FL
33133-4200
US

V. Phone/Fax

Practice location:
  • Phone: 305-859-9840
  • Fax:
Mailing address:
  • Phone: 305-859-9840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. HERNAN R BAQUERIZO
Title or Position: OWNER
Credential: MD
Phone: 305-859-9840