MEDICARE: EDGARDO ENRIQUE 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	124Q00000X	Dental Hygienist	22483	FL

General Provider Information

NPI Number	:	1942654710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDGARDO ENRIQUE HERNANDEZ

Provider Business Mailing Address
First Line	:	17175 NE 20TH AVE APT 8
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-3273
Country	:	US
Telephone Number	:	786-303-3334
Fax Number	:

Provider Business Practice Location Address
First Line	:	17175 NE 20TH AVE APT 8
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-3273
Country	:	US
Telephone Number	:	786-303-3334
Fax Number	:

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

Provider Enumeration Date	:	04/19/2016
Last Update Date	:	04/19/2016

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Directions to “ EDGARDO ENRIQUE HERNANDEZ ” Practice Location

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