=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831031665
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HERNANDEZ ROMAN PHYSICIAN ASSISTANT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2026
-----------------------------------------------------
Last Update Date | 04/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10989 SW 40TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33165-4412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-542-9937
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2138 SW 22ND TER
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33145-3709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-231-8183
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | JULIO C HERNANDEZ ROMAN
-----------------------------------------------------
Credential | PA-C
-----------------------------------------------------
Telephone | 786-231-8183
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------