Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | ME86608 | FL |
Y | 2080P0201X | Pediatric Allergist | ME86606 | FL |
NPI | 1962570309 |
---|---|
Provider Name | Mrs. Vivian P Hernandez-Trujillo |
First Address | Miami Lakes, FL 33014-6044 |
Second Address | Miami Lakes, FL 33014-6044 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2006 |
Last Update Date | 07/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U44942 | (02) | FL |