Provider Demographics
NPI:1528090255
Name:HERNANDEZ, DANIEL A (PA)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:A
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3461 FAIRLANE FARMS RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-8752
Mailing Address - Country:US
Mailing Address - Phone:561-766-1301
Mailing Address - Fax:561-693-0539
Practice Address - Street 1:7700 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33405-3340
Practice Address - Country:US
Practice Address - Phone:561-619-2843
Practice Address - Fax:561-720-2942
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103524207Q00000X, 173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45404Medicare ID - Type Unspecified