1578742201 NPI number — PABLO ANTONIO HERNANDEZ P.A.

Table of content: PABLO ANTONIO HERNANDEZ P.A. (NPI 1578742201)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578742201 NPI number — PABLO ANTONIO HERNANDEZ P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERNANDEZ
Provider First Name:
PABLO
Provider Middle Name:
ANTONIO
Provider Name Prefix Text:
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:
1578742201
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3131 NW 4TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33125-5053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-345-4262
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
721 NW 21ST CT
Provider Second Line Business Practice Location Address:
SUITE100
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33125-3434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-310-7115
Provider Business Practice Location Address Fax Number:
786-464-5125
Provider Enumeration Date:
10/30/2007

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: 363A00000X , with the licence number:  PA9100127 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PA9100127 . This is a "PHYSICIAN ASSISTANCE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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