Healthcare Provider Details

I. General information

NPI: 1366471864
Provider Name (Legal Business Name): HERNALDO NUNEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16555 NW 25TH AVE
OPA LOCKA FL
33054-6583
US

IV. Provider business mailing address

PO BOX 12493
MIAMI FL
33101-2493
US

V. Phone/Fax

Practice location:
  • Phone: 786-466-1732
  • Fax: 786-466-1670
Mailing address:
  • Phone: 305-585-4249
  • Fax: 305-355-2242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0065728
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: