Provider Demographics
NPI:1659173474
Name:MUTTIO HERNANDEZ, SERGIO
Entity type:Individual
Prefix:
First Name:SERGIO
Middle Name:
Last Name:MUTTIO HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEL MANANTIAL 14
Mailing Address - Street 2:COLONIA OLINCA
Mailing Address - City:SANTA CATARINA
Mailing Address - State:NUEVO LEON
Mailing Address - Zip Code:66188
Mailing Address - Country:MX
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1611 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-355-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program