# FIDEL HERNANDO HENRIQUEZ MD PA

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

## Provider details

- **NPI number:** 1851454839
- **Authorized official:** DR. FIDEL HERNANDO HENRIQUEZ MDPA (PHYSICIAN)
- **Authorized official phone:** (954) 442-1402

## Contact information

- **Practice address:** 10796 PINES BLVD, SUITE 103, PEMBROKE PINES, FL 33026-3919
- **Practice address phone:** (954) 442-1402
- **Practice address fax:** (954) 442-1418
- **Mailing address:** 10796 PINES BLVD, SUITE 103, PEMBROKE PINES, FL 33026-3919
- **Mailing address phone:** (954) 442-1402
- **Mailing address fax:** (954) 442-1418

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | ME0058002 | FL | Yes |

## Other

- **Enumeration date:** 12/19/2006
- **Last updated:** 05/27/2010