Healthcare Provider Details

I. General information

NPI: 1053378893
Provider Name (Legal Business Name): HERNAN R BAQUERIZO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 305-859-9837
  • Fax: 305-859-9840
Mailing address:
  • Phone: 305-859-9837
  • Fax: 305-859-9840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME-41627
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: