Provider Demographics
NPI:1336138023
Name:HERNANDEZ, LEONEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONEL
Middle Name:J
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LEONEL
Other - Middle Name:J
Other - Last Name:TOLEDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1777 S ANDREWS AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2517
Mailing Address - Country:US
Mailing Address - Phone:954-764-3954
Mailing Address - Fax:954-462-3286
Practice Address - Street 1:1777 S ANDREWS AVE
Practice Address - Street 2:SIOTE 202
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2517
Practice Address - Country:US
Practice Address - Phone:954-764-3954
Practice Address - Fax:954-462-3286
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 40895174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL042641500Medicaid
FLE21484Medicare UPIN
FL94457Medicare UPIN