Healthcare Provider Details

I. General information

NPI: 1528090255
Provider Name (Legal Business Name): DANIEL A HERNANDEZ P.A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7700 S DIXIE HWY
WEST PALM BEACH FL
33405-3340
US

IV. Provider business mailing address

3461 FAIRLANE FARMS RD SUITE 302
WELLINGTON FL
33414-8752
US

V. Phone/Fax

Practice location:
  • Phone: 561-619-2843
  • Fax: 561-720-2942
Mailing address:
  • Phone: 561-766-1301
  • Fax: 561-693-0539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA9103524
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberPA9103524
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: