Provider Demographics
NPI:1962665182
Name:HERNANDEZ, TERESITA D (MD)
Entity Type:Individual
Prefix:
First Name:TERESITA
Middle Name:D
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 1:10020 SW 40TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3946
Mailing Address - Country:US
Mailing Address - Phone:305-559-7330
Mailing Address - Fax:305-223-4767
Practice Address - Street 1:10020 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3946
Practice Address - Country:US
Practice Address - Phone:305-559-7330
Practice Address - Fax:305-223-4767
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93489207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274461900Medicaid
FLK9227ZOtherPTAN
FL1730133901OtherNPI
FL1962665182OtherNPI
FLK9227ZOtherPTAN