Provider Demographics
NPI:1174752265
Name:HERNANDEZ, VIVIAN (MD, FACS)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4799 NORTH FED HWY
Mailing Address - Street 2:SUITE #2
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431
Mailing Address - Country:US
Mailing Address - Phone:561-750-8600
Mailing Address - Fax:541-750-8602
Practice Address - Street 1:4799 NORTH FED HWY
Practice Address - Street 2:UNIT #4
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431
Practice Address - Country:US
Practice Address - Phone:561-750-8600
Practice Address - Fax:541-750-8602
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54911208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery