Provider Demographics
NPI:1427210970
Name:HERNANDEZ, JUAN (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 DEL PRADO BLVD
Mailing Address - Street 2:S-9
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-5616
Mailing Address - Country:US
Mailing Address - Phone:239-574-2644
Mailing Address - Fax:239-574-1451
Practice Address - Street 1:708 DEL PRADO BLVD
Practice Address - Street 2:S-9
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-5616
Practice Address - Country:US
Practice Address - Phone:239-574-2644
Practice Address - Fax:239-574-1451
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101136207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000228200Medicaid
FL0807910OtherCIGNA
FM52785OtherBCBS FL
FLP00667487OtherMEDICARE RAILROAD
FLAL835ZMedicare PIN