# PRESTIGE MEDICAL SERVICES INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013216597
- **Authorized official:** HUMBERTO HERNANDEZ (PRESIDENT)
- **Authorized official phone:** (305) 553-5600

## Contact information

- **Practice address:** 12905 SW 42ND ST STE 101, MIAMI, FL 33175-2910
- **Practice address phone:** (305) 553-5600
- **Practice address fax:** (305) 553-5602
- **Mailing address:** 12905 SW 42ND ST STE 101, MIAMI, FL 33175-2910
- **Mailing address phone:** (305) 553-5600
- **Mailing address fax:** (305) 553-5602

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | HCC9068 | FL | Yes |

## Other

- **Enumeration date:** 03/23/2011
- **Last updated:** 08/16/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | FC741A | MEDICARE PROVIDER | FL |