Provider Demographics
NPI:1235323486
Name:HERNANDO GIRALDO MD INC
Entity Type:Organization
Organization Name:HERNANDO GIRALDO MD INC
Other - Org Name:DELRAY MEDICAL & DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-859-5052
Mailing Address - Street 1:200 E HALLANDALE BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5525
Mailing Address - Country:US
Mailing Address - Phone:954-362-8677
Mailing Address - Fax:954-458-8167
Practice Address - Street 1:4765 W ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-3838
Practice Address - Country:US
Practice Address - Phone:561-453-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HERNANDO GIRALDO MD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-30
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45314Medicare UPIN