1528090255 NPI number — MR. DANIEL A HERNANDEZ P.A

Table of content: MR. DANIEL A HERNANDEZ P.A (NPI 1528090255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528090255 NPI number — MR. DANIEL A HERNANDEZ P.A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERNANDEZ
Provider First Name:
DANIEL
Provider Middle Name:
A
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
P.A
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528090255
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3461 FAIRLANE FARMS RD
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
WELLINGTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33414-8752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-766-1301
Provider Business Mailing Address Fax Number:
561-693-0539

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7700 S DIXIE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33405-3340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-619-2843
Provider Business Practice Location Address Fax Number:
561-720-2942
Provider Enumeration Date:
07/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  PA9103524 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 173000000X , with the licence number: PA9103524 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 105503200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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