Provider Demographics
NPI:1154312783
Name:HERNANDEZ, VINICIO (MD)
Entity Type:Individual
Prefix:MR
First Name:VINICIO
Middle Name:
Last Name:HERNANDEZ
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 1:7301 STONEROCK CIR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8002
Mailing Address - Country:US
Mailing Address - Phone:407-351-1002
Mailing Address - Fax:407-351-1119
Practice Address - Street 1:7301 STONEROCK CIRCLE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819
Practice Address - Country:US
Practice Address - Phone:407-351-1002
Practice Address - Fax:407-351-1096
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73340207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL429242Medicare ID - Type Unspecified
G36967Medicare UPIN