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General NPI Number Information
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NPI Number | 1114900875
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Entity Type | Organization
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Legal Business Name | HERNANDEZ MEDICAL CENTER CORP
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Dates
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Enumeration Date | 11/26/2005
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Last Update Date | 08/03/2011
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Provider Practice Location Address
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Address Line | 2720 SW 97TH AVE # 101
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City | MIAMI
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State | FL
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Zip | 33165-2677
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Country | US
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Telephone | 305-225-5652
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Fax | 305-225-5653
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Provider Business Mailing Address
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Address Line | 2720 SW 97TH AVE # 101
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City | MIAMI
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State | FL
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Zip | 33165-2677
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Country | US
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Telephone | 305-225-5652
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Fax | 305-225-5653
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ERIBERTO TORRES
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Credential |
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Telephone | 305-225-5652
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | AHCA HCC6126
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License Number State | FL
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