Provider Demographics
NPI:1982191037
Name:HERNANDEZ ROCHA, BAYARDO JOSE (MMS, PA-C)
Entity Type:Individual
Prefix:MR
First Name:BAYARDO
Middle Name:JOSE
Last Name:HERNANDEZ ROCHA
Suffix:
Gender:M
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 76TH ST APT 4
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-2300
Mailing Address - Country:US
Mailing Address - Phone:786-277-2777
Mailing Address - Fax:
Practice Address - Street 1:430 76TH ST APT 4
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-2300
Practice Address - Country:US
Practice Address - Phone:786-277-2777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-15
Last Update Date:2018-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9110845363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant