Organization
MIRTA HERNANDEZ, DPM PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MIRTA HERNANDEZ D.P.M. (PODIATRIST/PRESIDENT)
(305) 984-3865
Entity
Organization
Contact information
Practice address
14871 SW 39TH TER, MIAMI, FL 33185-4726
(305) 984-3865
(305) 207-1587
Mailing address
14871 SW 39TH TER, MIAMI, FL 33185-4726
(305) 984-3865
(305) 207-1587
Taxonomy
Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
PO2848
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
340317300
—
FL
01
—
K5491
MEDICARE GROUP
FL
Enumeration date
09/25/2007
Last updated
09/08/2023
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