Healthcare Provider Details

I. General information

NPI: 1922040898
Provider Name (Legal Business Name): JOSE ROBERTO HERNANDEZ JR. R EDT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9788 SW 24TH ST
MIAMI FL
33165-7574
US

IV. Provider business mailing address

14700 SW 57TH TER
MIAMI FL
33193-2499
US

V. Phone/Fax

Practice location:
  • Phone: 305-223-0224
  • Fax: 305-223-4001
Mailing address:
  • Phone: 305-383-5846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number561
License Number State
# 2
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number57895
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: