Provider Demographics
NPI:1366536799
Name:HERNANDEZ-GALA, JOSE P (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:P
Last Name:HERNANDEZ-GALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 NW 130 AVENUE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182
Mailing Address - Country:US
Mailing Address - Phone:305-642-4680
Mailing Address - Fax:305-642-4773
Practice Address - Street 1:1235 SW 27 AVENUE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135
Practice Address - Country:US
Practice Address - Phone:305-642-4680
Practice Address - Fax:305-642-4773
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0026136174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL059388500Medicaid
FLD58612Medicare UPIN
FL059388500Medicaid