Healthcare Provider Details

I. General information

NPI: 1790910982
Provider Name (Legal Business Name): EDUARDO GONZALEZ-HERNANDEZ MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 SW 42ND AVE SUITE 200
MIAMI FL
33134-1938
US

IV. Provider business mailing address

401 SW 42ND AVE SUITE 200
MIAMI FL
33134-1938
US

V. Phone/Fax

Practice location:
  • Phone: 786-270-3914
  • Fax: 786-270-3986
Mailing address:
  • Phone: 786-270-3914
  • Fax: 786-270-3986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EDUARDO GONZALEZ-HERNANDEZ
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 786-270-3914