Provider Demographics
NPI:1932408648
Name:LILIAM HERNANDEZ MD PA
Entity Type:Organization
Organization Name:LILIAM HERNANDEZ MD PA
Other - Org Name:LILIAM HERNANDEZ MD PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LILIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-789-8101
Mailing Address - Street 1:15380 SW 57TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-2515
Mailing Address - Country:US
Mailing Address - Phone:239-789-8101
Mailing Address - Fax:305-702-9442
Practice Address - Street 1:15380 SW 57TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-2515
Practice Address - Country:US
Practice Address - Phone:239-789-8101
Practice Address - Fax:305-702-9442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent MedicineGroup - Single Specialty