Provider Demographics
NPI:1396790598
Name:HERNANDEZ, JORGE ADOLFO (MD)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:ADOLFO
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 PONCE DE LEON BLVD STE 228
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2070
Mailing Address - Country:US
Mailing Address - Phone:305-665-2911
Mailing Address - Fax:305-479-2745
Practice Address - Street 1:717 PONCE DE LEON BLVD STE 228
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2070
Practice Address - Country:US
Practice Address - Phone:305-822-1993
Practice Address - Fax:305-479-2745
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME947232084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry