Provider Demographics
NPI:1336298892
Name:HERNANDEZ, CECILIO (MD)
Entity Type:Individual
Prefix:
First Name:CECILIO
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 1:4102 N MACDILL AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6717
Mailing Address - Country:US
Mailing Address - Phone:813-870-3979
Mailing Address - Fax:813-877-1609
Practice Address - Street 1:4102 N MACDILL AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6717
Practice Address - Country:US
Practice Address - Phone:813-657-0027
Practice Address - Fax:813-877-1609
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68187207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378115100Medicaid
FL26799Medicare ID - Type Unspecified
FL378115100Medicaid