Healthcare Provider Details

I. General information

NPI: 1659564094
Provider Name (Legal Business Name): ERNESTO JOSE DEL VALLE HERNANDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 09/04/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N ORANGE AVE STE 514
ORLANDO FL
32804-4674
US

IV. Provider business mailing address

2501 N ORANGE AVE STE 514
ORLANDO FL
32804-4674
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-5687
  • Fax: 407-303-0806
Mailing address:
  • Phone: 407-303-5687
  • Fax: 407-303-0806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberME121285
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number019705
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number11735-I
License Number StatePR
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME121285
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: