Provider Demographics
NPI:1619248267
Name:HERNANDEZ, JOSE L (LMT)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:L
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 SW 210TH ST APTO 204
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-4035
Mailing Address - Country:US
Mailing Address - Phone:786-768-1476
Mailing Address - Fax:305-328-9638
Practice Address - Street 1:8000 SW 210TH ST APTO 204
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-4035
Practice Address - Country:US
Practice Address - Phone:786-768-1476
Practice Address - Fax:305-328-9638
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center