Provider Demographics
NPI:1609994508
Name:HEVIA, OSCAR (MD)
Entity Type:Individual
Prefix:MR
First Name:OSCAR
Middle Name:
Last Name:HEVIA
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 1:4425 PONCE DE LEON BLVD
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-1837
Mailing Address - Country:US
Mailing Address - Phone:305-443-6606
Mailing Address - Fax:305-443-4890
Practice Address - Street 1:4425 PONCE DE LEON BLVD
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-1837
Practice Address - Country:US
Practice Address - Phone:305-443-6606
Practice Address - Fax:305-443-4890
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53902174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE82201Medicare UPIN