Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | PO3424 | FL |
NPI | 1104069079 |
---|---|
Provider Name | Dr. Jorge Hernandez |
First Address | Miramar, FL 33027-3875 |
Second Address | Hialeah, FL 33018-4906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2009 |
Last Update Date | 18/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PO3424 | FLORIDA LICENCE (01) | FL |