Healthcare Provider Details

I. General information

NPI: 1649579681
Provider Name (Legal Business Name): YOEL A HERNANDEZ MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2011
Last Update Date: 06/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 SW 172ND AVE STE 200
MIRAMAR FL
33029-5613
US

IV. Provider business mailing address

13079 NW 23RD ST
PEMBROKE PINES FL
33028-2549
US

V. Phone/Fax

Practice location:
  • Phone: 954-256-8181
  • Fax: 954-256-8155
Mailing address:
  • Phone: 561-451-6464
  • Fax: 954-256-8155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME106099
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License NumberME106099
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberME 106099
License Number StateFL

VIII. Authorized Official

Name: YOEL A HERNANDEZ RODRIGUEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 561-451-6464