Basic Information
| Provider Information | |||||||||
| NPI: | 1609215771 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRESPO | ||||||||
| FirstName: | HECTOR | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 90 SW 79TH AVE | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331442220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7862297987 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11760 SW 40TH ST STE 352 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331753595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055521005 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2013 | ||||||||
| LastUpdateDate: | 07/02/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME 122563 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0011X | ME122563 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | ME 122563 | 01 | FL | MEDICAL LICENSE | OTHER |