Provider Demographics
NPI:1225217698
Name:HUMBERTO J HERNANDEZ
Entity Type:Organization
Organization Name:HUMBERTO J HERNANDEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HUMBERTO
Authorized Official - Middle Name:J
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-553-0007
Mailing Address - Street 1:1435 W 49 PL
Mailing Address - Street 2:SUITE 604
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3158
Mailing Address - Country:US
Mailing Address - Phone:305-885-3111
Mailing Address - Fax:
Practice Address - Street 1:1435 W 49 PL
Practice Address - Street 2:SUITE 604
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3158
Practice Address - Country:US
Practice Address - Phone:305-885-3111
Practice Address - Fax:305-885-5884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1222460001Medicare NSC