Healthcare Provider Details

I. General information

NPI: 1972367167
Provider Name (Legal Business Name): JESSICA OLIVA HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2024
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15255 SW 137TH AVE
MIAMI FL
33177-8117
US

IV. Provider business mailing address

15255 SW 137TH AVE
MIAMI FL
33177-8117
US

V. Phone/Fax

Practice location:
  • Phone: 305-233-8499
  • Fax:
Mailing address:
  • Phone: 305-233-8499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS66774
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: