Basic Information
| Provider Information | |||||||||
| NPI: | 1649498569 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERNANDEZ-LOPEZ | ||||||||
| FirstName: | PEDRO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4408 SW 195TH TER | ||||||||
| Address2: | |||||||||
| City: | MIRAMAR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330296201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9546683101 | ||||||||
| FaxNumber: | 9542288183 | ||||||||
| Practice Location | |||||||||
| Address1: | 302 NW 179TH AVE STE 102 | ||||||||
| Address2: | |||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330292818 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9546683101 | ||||||||
| FaxNumber: | 9542288183 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2007 | ||||||||
| LastUpdateDate: | 10/24/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | ME105945 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 002366700 | 05 | FL | MEDICAID |