Healthcare Provider Details

I. General information

NPI: 1982891834
Provider Name (Legal Business Name): MIRTA HERNANDEZ, DPM PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14871 SW 39TH TER
MIAMI FL
33185-4726
US

IV. Provider business mailing address

14871 SW 39TH TER
MIAMI FL
33185-4726
US

V. Phone/Fax

Practice location:
  • Phone: 305-984-3865
  • Fax: 305-207-1587
Mailing address:
  • Phone: 305-984-3865
  • Fax: 305-207-1587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO2848
License Number StateFL

VIII. Authorized Official

Name: DR. MIRTA HERNANDEZ
Title or Position: PODIATRIST/PRESIDENT
Credential: D.P.M.
Phone: 305-984-3865