Provider Demographics
NPI:1649371766
Name:HERNANDEZ, ILIANA (MD)
Entity type:Individual
Prefix:
First Name:ILIANA
Middle Name:
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 1:13274 SW 13TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-1906
Mailing Address - Country:US
Mailing Address - Phone:786-234-8724
Mailing Address - Fax:
Practice Address - Street 1:1645 NE 8TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-4712
Practice Address - Country:US
Practice Address - Phone:305-248-7474
Practice Address - Fax:305-242-4344
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80606207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259426900Medicaid
FLE4371AMedicare ID - Type Unspecified
FL259426900Medicaid