Provider Demographics
NPI:1104069079
Name:HERNANDEZ, JORGE (DPM)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13315 SW 26TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-3875
Mailing Address - Country:US
Mailing Address - Phone:787-598-1000
Mailing Address - Fax:
Practice Address - Street 1:3410 W 84TH ST STE 100
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-4906
Practice Address - Country:US
Practice Address - Phone:305-667-5683
Practice Address - Fax:305-826-7774
Is Sole Proprietor?:No
Enumeration Date:2009-04-08
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3424213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPO3424OtherFLORIDA LICENCE