Healthcare Provider Details

I. General information

NPI: 1164060497
Provider Name (Legal Business Name): ADVANCED VASCULAR CARDIAC & VEINS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7480 BIRD RD STE 560
MIAMI FL
33155-6657
US

IV. Provider business mailing address

7480 BIRD RD STE 560
MIAMI FL
33155-6657
US

V. Phone/Fax

Practice location:
  • Phone: 305-450-1239
  • Fax:
Mailing address:
  • Phone: 305-707-5688
  • Fax: 305-760-4149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: ENRIQUE HERNANDEZ
Title or Position: OWNER, AUTHORIZED OFFICIAL
Credential: MD
Phone: 917-684-9225