Healthcare Provider Details

I. General information

NPI: 1205875291
Provider Name (Legal Business Name): ALICE W HERNANDEZ-BEM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 NE 164TH ST
NORTH MIAMI BEACH FL
33162-4018
US

IV. Provider business mailing address

PO BOX 144598
CORAL GABLES FL
33114-4598
US

V. Phone/Fax

Practice location:
  • Phone: 305-949-2000
  • Fax:
Mailing address:
  • Phone: 305-949-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number39574
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: