Healthcare Provider Details

I. General information

NPI: 1285728840
Provider Name (Legal Business Name): YAMIR HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 04/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 GRAND CANAL DR STE.# 401
MIAMI FL
33144-2561
US

IV. Provider business mailing address

85 GRAND CANAL DR STE.# 401
MIAMI FL
33144-2561
US

V. Phone/Fax

Practice location:
  • Phone: 305-262-6158
  • Fax:
Mailing address:
  • Phone: 305-773-6562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number62896
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: