FIDEL HERNANDO HENRIQUEZ MD PA
Osteopathic Medicine at Pines Blvd, Hollywood, FL

License number
Florida ME0058002
Category
Osteopathic Medicine
Type
Endocrinology, Diabetes & Metabolism
Owner
Name: DR. FIDEL HERNANDO HENRIQUEZ MDPA
Title: PHYSICIAN
Phone: (954) 442-1402
Address
Address
10796 Pines Blvd SUITE 103, Hollywood, FL 33026
National Provider ID: 1851454839
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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FIDEL HERNANDO HENRIQUEZ, M.D., PA

Hollywood, FL  -  Miami, FL

Status:
Inactive
Inactive reason:
REINSTATEMENT
Registration:
Feb 24, 1997
Inactive since:
Apr 16, 1999
Addresses:
10796 Pne Blvd #103, Hollywood, FL 33026 (Physical)
200 S Biscayne Blvd SUITE #2600, Miami, FL 33131 (Mailing)
201 S Biscayne Blvd, Miami, FL 33131
State ID:
P97000017103
Business type:
Florida Profit Corporation
Chairman, Secretarys:
Fidel Hmd Henriquez (Director, President), 10796 Pne Blvd #103, Hollywood, FL 33026 (Physical),Amarilis Henriquez (Chairman, Secretary), 10796 Pne Blvd, Hollywood, FL 33026 (Physical)
Agent:
Marc Auerbach,200 S Biscayne Blvd SUITE #2600, Miami, FL 33131 (Physical)
EIN:
65-0725749

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