Provider Demographics
NPI:1053378893
Name:BAQUERIZO, HERNAN R (MD)
Entity type:Individual
Prefix:DR
First Name:HERNAN
Middle Name:R
Last Name:BAQUERIZO
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 1:3661 S MIAMI AVE
Mailing Address - Street 2:# 505
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-4200
Mailing Address - Country:US
Mailing Address - Phone:305-859-9837
Mailing Address - Fax:305-859-9840
Practice Address - Street 1:3661 S MIAMI AVE
Practice Address - Street 2:# 505
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-4200
Practice Address - Country:US
Practice Address - Phone:305-859-9837
Practice Address - Fax:305-859-9840
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-41627207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME-41627OtherMEDICAL LICENSE
FL2632209-00Medicaid
FL2632209-00Medicaid
FLME-41627OtherMEDICAL LICENSE
E65712Medicare UPIN