MEDICARE: YOEL A HERNANDEZ MD PA

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	282E00000X	Long Term Care Hospital	ME106099	FL
2	282N00000X	General Acute Care Hospital	ME 106099	FL
3	207R00000X	Internal Medicine Physician	ME106099	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME106099	OTHER	FL	MEDICAL LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649579681
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOEL A HERNANDEZ MD PA

Provider Business Mailing Address
First Line	:	13079 NW 23RD ST
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33028-2549
Country	:	US
Telephone Number	:	561-451-6464
Fax Number	:	954-256-8155

Provider Business Practice Location Address
First Line	:	1951 SW 172ND AVE STE 200
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33029-5613
Country	:	US
Telephone Number	:	954-256-8181
Fax Number	:	954-256-8155

Authorized Official
Title or Position	:	PRESIDENT
Name	:	YOEL A HERNANDEZ RODRIGUEZ
Credential	:	MD
Telephone Number	:	561-451-6464

Provider Enumeration Date	:	03/16/2011
Last Update Date	:	06/25/2014

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