Basic Information
| Provider Information | |||||||||
| NPI: | 1699056556 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERNANDEZ | ||||||||
| FirstName: | GISELLE | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1611 NW 12TH AVE # 303 | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331361005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052433000 | ||||||||
| FaxNumber: | 3053247658 | ||||||||
| Practice Location | |||||||||
| Address1: | 9333 SW 152ND ST | ||||||||
| Address2: | |||||||||
| City: | PALMETTO BAY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331571778 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052512500 | ||||||||
| FaxNumber: | 4786338698 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2011 | ||||||||
| LastUpdateDate: | 09/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 078121 | GA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 208600000X | MT199428 | PA | N | Allopathic & Osteopathic Physicians | Surgery | 207X00000X | ME137259 | FL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 003192393A | 05 | GA | MEDICAID | 1007727-00 | 05 | FL | MEDICAID |