Healthcare Provider Details

I. General information

NPI: 1083699490
Provider Name (Legal Business Name): DR OSCAR L HERNANDEZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 07/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14221 SW 120TH ST STE 129
MIAMI FL
33186
US

IV. Provider business mailing address

14221 SW 120TH ST STE 129
MIAMI FL
33186
US

V. Phone/Fax

Practice location:
  • Phone: 305-279-1515
  • Fax: 305-279-1219
Mailing address:
  • Phone: 305-279-1515
  • Fax: 305-279-1219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME57645
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME57645
License Number StateFL

VIII. Authorized Official

Name: MR. OSCAR L HERNANDEZ SR.
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 305-279-1515