Healthcare Provider Details

I. General information

NPI: 1053125138
Provider Name (Legal Business Name): JULIO HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7800 NW 25TH ST STE 4
MIAMI FL
33122-1623
US

IV. Provider business mailing address

12970 SW 142ND TER
MIAMI FL
33186-8925
US

V. Phone/Fax

Practice location:
  • Phone: 305-593-2174
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPTT42814
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: