Healthcare Provider Details

I. General information

NPI: 1619101037
Provider Name (Legal Business Name): YESENIA P HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2009
Last Update Date: 05/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6705 S RED RD SUITE 706
SOUTH MIAMI FL
33143-3622
US

IV. Provider business mailing address

6705 S RED RD SUITE 600
SOUTH MIAMI FL
33143-3622
US

V. Phone/Fax

Practice location:
  • Phone: 305-663-3380
  • Fax: 786-533-1502
Mailing address:
  • Phone: 305-667-4515
  • Fax: 786-533-1502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: