MEDICARE: GRISELL HERNANDEZ

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	261QR0200X	Radiology Clinic/Center
2	261QR0206X	Mammography Clinic/Center

General Provider Information

NPI Number	:	1598944894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRISELL HERNANDEZ

Provider Business Mailing Address
First Line	:	2348 NW 7TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-3249
Country	:	US
Telephone Number	:	305-541-2888
Fax Number	:

Provider Business Practice Location Address
First Line	:	2348 NW 7TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-3249
Country	:	US
Telephone Number	:	305-541-2888
Fax Number	:

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

Provider Enumeration Date	:	11/02/2007
Last Update Date	:	11/02/2007

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Directions to “ GRISELL HERNANDEZ ” Practice Location

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