Provider Demographics
NPI:1982891834
Name:MIRTA HERNANDEZ, DPM PA
Entity Type:Organization
Organization Name:MIRTA HERNANDEZ, DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRTA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:305-984-3865
Mailing Address - Street 1:14871 SW 39TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4726
Mailing Address - Country:US
Mailing Address - Phone:305-984-3865
Mailing Address - Fax:305-207-1587
Practice Address - Street 1:14871 SW 39TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-4726
Practice Address - Country:US
Practice Address - Phone:305-984-3865
Practice Address - Fax:305-207-1587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2848213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340317300Medicaid
FLK5491OtherMEDICARE GROUP
FLU82769Medicare UPIN
FL340317300Medicaid