Provider Demographics
NPI:1922040898
Name:HERNANDEZ, JOSE ROBERTO JR (R EDT)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ROBERTO
Last Name:HERNANDEZ
Suffix:JR
Gender:M
Credentials:R EDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14700 SW 57TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-2499
Mailing Address - Country:US
Mailing Address - Phone:305-383-5846
Mailing Address - Fax:
Practice Address - Street 1:9788 SW 24TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7574
Practice Address - Country:US
Practice Address - Phone:305-223-0224
Practice Address - Fax:305-223-4001
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
561246ZE0600X
FL57895247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
Not Answered247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist