Healthcare Provider Details

I. General information

NPI: 1326604885
Provider Name (Legal Business Name): MIGUEL R GARDEN HERNANDEZ MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2019
Last Update Date: 05/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MEDICAL PKWY
ANNAPOLIS MD
21401-3773
US

IV. Provider business mailing address

132 ALVIEW TER
GLEN BURNIE MD
21060-7452
US

V. Phone/Fax

Practice location:
  • Phone: 786-487-9951
  • Fax:
Mailing address:
  • Phone: 786-487-9951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. MIGUEL RODOLFO GARDEN
Title or Position: SURGICAL ASSISTANT CERTIFIED SA-C
Credential: MD
Phone: 786-487-9951