Provider Demographics
NPI:1093350738
Name:HERNANDEZ, RICARDO ANTONIO JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:ANTONIO
Last Name:HERNANDEZ
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RICARDO
Other - Middle Name:A
Other - Last Name:HERNANDEZ
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3890 TURTLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-9358
Mailing Address - Country:US
Mailing Address - Phone:863-837-9781
Mailing Address - Fax:386-756-3031
Practice Address - Street 1:3890 TURTLE CREEK DR
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-9358
Practice Address - Country:US
Practice Address - Phone:863-837-9781
Practice Address - Fax:386-756-3031
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-15
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR021852208D00000X
FLACN1301208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice