Healthcare Provider Details

I. General information

NPI: 1558650820
Provider Name (Legal Business Name): MARLENE HERNANDEZ M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2011
Last Update Date: 05/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 SW 62ND AVE SUITE 300
SOUTH MIAMI FL
33143-4716
US

IV. Provider business mailing address

14120 SW 147TH CT
MIAMI FL
33196-5045
US

V. Phone/Fax

Practice location:
  • Phone: 305-284-7500
  • Fax:
Mailing address:
  • Phone: 786-242-9595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN386
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number17992
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: