Provider Demographics
NPI:1730133901
Name:TERESITA D HERNANDEZ MDPA
Entity Type:Organization
Organization Name:TERESITA D HERNANDEZ MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERESITA
Authorized Official - Middle Name:D
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-559-7330
Mailing Address - Street 1:3400 SW 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3633
Mailing Address - Country:US
Mailing Address - Phone:305-559-7330
Mailing Address - Fax:305-223-4767
Practice Address - Street 1:10710 SW 34TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3615
Practice Address - Country:US
Practice Address - Phone:305-559-7330
Practice Address - Fax:305-223-4767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93489261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274461900Medicaid
FL149550Medicare UPIN
FL274461900Medicaid