Provider Demographics
NPI:1760433429
Name:HERNANDEZ, JOSEFINA J (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEFINA
Middle Name:J
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 1:1316 SW 150TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33194-2538
Mailing Address - Country:US
Mailing Address - Phone:305-261-4341
Mailing Address - Fax:
Practice Address - Street 1:1316 SW 150TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33194-2538
Practice Address - Country:US
Practice Address - Phone:305-261-4341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 84344207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265362100Medicaid
FLH73369Medicare UPIN
FL62663AMedicare ID - Type Unspecified