Provider Demographics
NPI:1013186576
Name:LIZETTE S. HERNANDEZ, M.D., P.A.
Entity Type:Organization
Organization Name:LIZETTE S. HERNANDEZ, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LIZETTE
Authorized Official - Middle Name:SONIA
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-933-4826
Mailing Address - Street 1:3709 W HAMILTON AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-4015
Mailing Address - Country:US
Mailing Address - Phone:813-933-4826
Mailing Address - Fax:813-931-8595
Practice Address - Street 1:3709 W HAMILTON AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-4015
Practice Address - Country:US
Practice Address - Phone:813-933-4826
Practice Address - Fax:813-931-8595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0064363207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Single Specialty