Provider Demographics
NPI:1508821620
Name:HERNANDEZ-PUGA, ANA MARIA (MD)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:MARIA
Last Name:HERNANDEZ-PUGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANA
Other - Middle Name:M
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9220 SW 72ND ST STE 102
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3259
Mailing Address - Country:US
Mailing Address - Phone:305-275-1700
Mailing Address - Fax:305-275-1700
Practice Address - Street 1:9220 SW 72ND ST STE 102
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173
Practice Address - Country:US
Practice Address - Phone:305-275-1700
Practice Address - Fax:305-275-1700
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72370208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252445700Medicaid
FL252445700Medicaid