| Entity Name: | HERNANDEZ MEDICAL GROUP L.L.C. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 14 Sep 2017 (7 years ago) |
| Document Number: | L17000191500 |
| FEI/EIN Number | N/A |
| Address: | 165 CAMERON DRIVE, WESTON, FL 33326 |
| Mail Address: | 165 CAMERON DRIVE, WESTON, FL 33326 |
| ZIP code: | 33326 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1669991873 | 2017-09-19 | 2017-09-19 | 165 CAMERON DR, WESTON, FL, 333263514, US | 2001 W 68TH ST, HIALEAH, FL, 330161801, US | |||||||||||||||||||||||||||||||
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| Phone | +1 305-900-8170 |
| Phone | +1 305-823-5000 |
Authorized person
| Name | DR. EMMANUEL HERNANDEZ |
| Role | MEDICAL DOCTOR |
| Phone | 3059008170 |
Taxonomy
| Taxonomy Code | 207R00000X - Internal Medicine Physician |
| License Number | OS12178 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI INDIVIDUAL |
| Number | 1134418668 |
| State | FL |
| Issuer | MEDICAID |
| Number | 012315900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| HERNANDEZ, EMMANUEL | Agent | 165 CAMERON DRIVE, WESTON, FL 33326 |
| Name | Role | Address |
|---|---|---|
| HERNANDEZ, EMMANUEL | Manager | 165 CAMERON DRIVE, WESTON, FL 33326 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-09 |
| ANNUAL REPORT | 2023-01-28 |
| ANNUAL REPORT | 2022-02-24 |
| ANNUAL REPORT | 2021-03-16 |
| ANNUAL REPORT | 2020-03-26 |
| ANNUAL REPORT | 2019-05-13 |
| ANNUAL REPORT | 2018-07-18 |
| Florida Limited Liability | 2017-09-14 |
Date of last update: 18 Jan 2025
Sources: Florida Department of State
