Healthcare Provider Details

I. General information

NPI: 1568755221
Provider Name (Legal Business Name): MARLOW BLAS HERNANDEZ D.O., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date: 12/10/2024
Reactivation Date: 01/09/2025

III. Provider practice location address

3399 NW 72ND AVE STE 101
MIAMI FL
33122-1355
US

IV. Provider business mailing address

10608 INDIAN TRL
COOPER CITY FL
33328-5512
US

V. Phone/Fax

Practice location:
  • Phone: 786-698-8734
  • Fax:
Mailing address:
  • Phone: 954-448-3647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberOS11834
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberOS11834
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS11834
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: