Healthcare Provider Details

I. General information

NPI: 1568497485
Provider Name (Legal Business Name): PEDRO JORGE HERNANDEZ-RIOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PEDRO JORGE HERNANDEZ MD MPH

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19411 NW 2ND AVE
MIAMI FL
33169-3314
US

IV. Provider business mailing address

19411 NW 2ND AVE
MIAMI FL
33169-3314
US

V. Phone/Fax

Practice location:
  • Phone: 305-653-5056
  • Fax:
Mailing address:
  • Phone: 305-653-5056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberME0066967
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME0066967
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: