Provider Demographics
NPI:1679695027
Name:HERNANDEZ, ANTONIO C (RDMS (AB) RVT (VT))
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:C
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:RDMS (AB) RVT (VT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12015 SW 18TH TER # 18
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-1678
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3360 NW 72ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33122-1320
Practice Address - Country:US
Practice Address - Phone:305-599-2762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL98570246XC2903X, 246XS1301X, 247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular Specialist
Not Answered246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonography
Not Answered247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other