MEDICARE: JORGE ADOLFO HERNANDEZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	ME94723	FL

General Provider Information

NPI Number	:	1396790598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE ADOLFO HERNANDEZ M.D.

Provider Business Mailing Address
First Line	:	717 PONCE DE LEON BLVD STE 228
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-2070
Country	:	US
Telephone Number	:	305-665-2911
Fax Number	:	305-479-2745

Provider Business Practice Location Address
First Line	:	717 PONCE DE LEON BLVD STE 228
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-2070
Country	:	US
Telephone Number	:	305-822-1993
Fax Number	:	305-479-2745

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	03/20/2012

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