Provider Demographics
NPI:1568497485
Name:HERNANDEZ-RIOS, PEDRO JORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:JORGE
Last Name:HERNANDEZ-RIOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:PEDRO
Other - Middle Name:JORGE
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD MPH
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:305-500-2000
Mailing Address - Fax:
Practice Address - Street 1:12177 PEMBROKE RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-1727
Practice Address - Country:US
Practice Address - Phone:954-466-5412
Practice Address - Fax:954-436-0108
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066967207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F93232Medicare UPIN