Provider Demographics
NPI:1043405558
Name:HERNANDEZ-TRUJILLO, JUAN MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:MANUEL
Last Name:HERNANDEZ-TRUJILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14505 COMMERCE WAY
Mailing Address - Street 2:SUITE 800
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1597
Mailing Address - Country:US
Mailing Address - Phone:305-821-7717
Mailing Address - Fax:305-821-9077
Practice Address - Street 1:14505 COMMERCE WAY
Practice Address - Street 2:SUITE 800
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1597
Practice Address - Country:US
Practice Address - Phone:305-821-7717
Practice Address - Fax:305-821-9077
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME33835208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378700100Medicaid