Provider Demographics
NPI:1619940772
Name:HERNANDEZ, ALEIDA MAXIMA (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEIDA
Middle Name:MAXIMA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1470 NW 107TH AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2744
Mailing Address - Country:US
Mailing Address - Phone:305-594-8666
Mailing Address - Fax:305-594-0088
Practice Address - Street 1:1470 NW 107TH AVE
Practice Address - Street 2:SUITE F
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-2744
Practice Address - Country:US
Practice Address - Phone:305-594-8666
Practice Address - Fax:305-594-0088
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66407208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF89907Medicare UPIN
FL25350Medicare ID - Type UnspecifiedPROVIDER NUMBER