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General NPI Number Information
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NPI Number | 1851426019
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Entity Type | Organization
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Legal Business Name | PINECREST FAMILY MEDICINE INC
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 10/13/2010
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Provider Practice Location Address
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Address Line | 8353 SW 124TH ST SUITE 201
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City | MIAMI
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State | FL
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Zip | 33156-5847
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Country | US
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Telephone | 305-235-4141
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Fax | 305-235-4381
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Provider Business Mailing Address
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Address Line | 8353 SW 124TH ST SUITE 201
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City | MIAMI
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State | FL
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Zip | 33156-5847
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Country | US
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Telephone | 305-235-4141
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Fax | 305-235-4381
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AGUEDA HERNANDEZ
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Credential | MD
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Telephone | 305-235-4141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME89580
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License Number State | FL
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