Healthcare Provider Details

I. General information

NPI: 1275462707
Provider Name (Legal Business Name): MR. RAMON HERNANDEZ SARDUY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10571 SW 56TH TER
MIAMI FL
33173-2861
US

IV. Provider business mailing address

11186 SW 75TH TER
MIAMI FL
33173-2644
US

V. Phone/Fax

Practice location:
  • Phone: 786-676-5770
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number20241213144389
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: