Basic Information
Provider Information
NPI: 1255792149
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HERNANDEZ
FirstName: LYNN
MiddleName: M
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4300 ALTON RD
Address2:  
City: MIAMI BEACH
State: FL
PostalCode: 331402948
CountryCode: US
TelephoneNumber: 7864754970
FaxNumber: 3372896006
Practice Location
Address1: 4300 ALTON RD
Address2:  
City: MIAMI BEACH
State: FL
PostalCode: 331402948
CountryCode: US
TelephoneNumber: 3054819776
FaxNumber: 3056742007
Other Information
ProviderEnumerationDate: 03/18/2016
LastUpdateDate: 10/21/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/21/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000XOS15997FLN Allopathic & Osteopathic PhysiciansHospitalist 
207R00000XOS15997FLY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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