=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437534146
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEBERTO HERNANDEZ
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/23/2015
-----------------------------------------------------
Last Update Date | 04/12/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9134 NW 25TH ST
-----------------------------------------------------
City | DORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33172-1502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-542-5007
-----------------------------------------------------
Fax | 786-542-5890
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9134 NW 25TH ST
-----------------------------------------------------
City | DORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33172-1502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-542-5007
-----------------------------------------------------
Fax | 786-542-5890
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS41667
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------