Provider Demographics
NPI:1366893232
Name:HERNANDEZ ROMAN NEPHROLOGY CORP
Entity type:Organization
Organization Name:HERNANDEZ ROMAN NEPHROLOGY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:HERNANDEZ ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-639-8735
Mailing Address - Street 1:4191 EL PRADO BLVD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-6311
Mailing Address - Country:US
Mailing Address - Phone:305-639-8735
Mailing Address - Fax:786-332-4357
Practice Address - Street 1:10710 SW 38TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3619
Practice Address - Country:US
Practice Address - Phone:305-639-8735
Practice Address - Fax:786-332-4357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME124673207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty