Healthcare Provider Details

I. General information

NPI: 1194878595
Provider Name (Legal Business Name): JOSE NOEL HERNANDEZ P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11210 SW 188TH ST
MIAMI FL
33157-7529
US

IV. Provider business mailing address

11210 SW 188TH ST
MIAMI FL
33157-7529
US

V. Phone/Fax

Practice location:
  • Phone: 305-884-8880
  • Fax: 305-884-7740
Mailing address:
  • Phone: 305-884-8880
  • Fax: 305-884-7740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9100229
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: