Provider Demographics
NPI:1851955454
Name:HERNANDEZ, EUGENIO ALXIDE
Entity Type:Individual
Prefix:
First Name:EUGENIO
Middle Name:ALXIDE
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:EUGENIO
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:7235 CORAL WAY STE 208
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1452
Mailing Address - Country:US
Mailing Address - Phone:786-385-1730
Mailing Address - Fax:
Practice Address - Street 1:7235 CORAL WAY STE 208
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1452
Practice Address - Country:US
Practice Address - Phone:786-385-1730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-29
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45837111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor