Provider Demographics
NPI:1962570309
Name:HERNANDEZ-TRUJILLO, VIVIAN P (MD,)
Entity type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:P
Last Name:HERNANDEZ-TRUJILLO
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 1:16371 NW 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-6044
Mailing Address - Country:US
Mailing Address - Phone:786-646-9280
Mailing Address - Fax:
Practice Address - Street 1:16371 NW 67TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-6044
Practice Address - Country:US
Practice Address - Phone:786-646-9280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME866062080P0201X
FLME86608207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU44942Medicare UPIN