Provider Demographics
NPI:1437534146
Name:HERNANDEZ, HEBERTO
Entity Type:Individual
Prefix:
First Name:HEBERTO
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9134 NW 25TH ST
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-1502
Mailing Address - Country:US
Mailing Address - Phone:786-542-5007
Mailing Address - Fax:786-542-5890
Practice Address - Street 1:9134 NW 25TH ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-1502
Practice Address - Country:US
Practice Address - Phone:786-542-5007
Practice Address - Fax:786-542-5890
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41667183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist