=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578819769
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JORGE A HERNANDEZ PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2012
-----------------------------------------------------
Last Update Date | 06/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2701 EXECUTIVE PARK DR STE 3
-----------------------------------------------------
City | WESTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33331-3632
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-328-9770
-----------------------------------------------------
Fax | 954-212-9817
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13315 SW 26TH ST
-----------------------------------------------------
City | MIRAMAR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33027-3875
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-598-1000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR/OWNER
-----------------------------------------------------
Name | DR. JORGE A HERNANDEZ
-----------------------------------------------------
Credential | D.P.M
-----------------------------------------------------
Telephone | 787-598-1000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | PO 3424
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------