=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396790598
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JORGE ADOLFO HERNANDEZ M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2006
-----------------------------------------------------
Last Update Date | 03/20/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 717 PONCE DE LEON BLVD STE 228
-----------------------------------------------------
City | CORAL GABLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33134-2070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-822-1993
-----------------------------------------------------
Fax | 305-479-2745
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 717 PONCE DE LEON BLVD STE 228
-----------------------------------------------------
City | CORAL GABLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33134-2070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-665-2911
-----------------------------------------------------
Fax | 305-479-2745
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0804X
-----------------------------------------------------
Taxonomy Name | Child & Adolescent Psychiatry Physician
-----------------------------------------------------
License Number | ME94723
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------