Provider Demographics
NPI:1386835742
Name:ANA M HERNANDEZ D O P A
Entity Type:Organization
Organization Name:ANA M HERNANDEZ D O P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-441-7696
Mailing Address - Street 1:601 NW 179TH AVE
Mailing Address - Street 2:SUITE # 104
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2819
Mailing Address - Country:US
Mailing Address - Phone:954-441-7696
Mailing Address - Fax:954-441-7967
Practice Address - Street 1:601 NW 179TH AVE
Practice Address - Street 2:SUITE # 104
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2819
Practice Address - Country:US
Practice Address - Phone:954-441-7696
Practice Address - Fax:954-441-7967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6651207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty