Provider Demographics
NPI:1699730903
Name:HERNANDEZ, AGUEDA (MD)
Entity type:Individual
Prefix:
First Name:AGUEDA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8353 SW 124TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-5851
Mailing Address - Country:US
Mailing Address - Phone:305-235-4141
Mailing Address - Fax:305-235-4381
Practice Address - Street 1:8353 SW 124TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-5851
Practice Address - Country:US
Practice Address - Phone:305-235-4141
Practice Address - Fax:305-235-4381
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89580207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263710300Medicaid
FLH21691Medicare UPIN
FL15335Medicare ID - Type Unspecified