Healthcare Provider Details

I. General information

NPI: 1194776773
Provider Name (Legal Business Name): VIVIAN HERNANDEZ-POPP M.D,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 01/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8740 N KENDALL DR STE 114
MIAMI FL
33176-2209
US

IV. Provider business mailing address

8740 N KENDALL DR STE 114
MIAMI FL
33176-2209
US

V. Phone/Fax

Practice location:
  • Phone: 305-275-9990
  • Fax: 305-275-9433
Mailing address:
  • Phone: 305-275-9990
  • Fax: 305-275-9433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME 72185
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: