Mario Heredia, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9108764 Issued in FL

Practice address

711 E Altamonte Dr Ste 210
Altamonte Springs, FL 32701-4824

Phone

(407) 303-5452

Fax

(407) 303-5448

NPI assigned

Jul 10, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mario Alfredo Heredia Blanco Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Florida Hospital Medical Group Inc

  dba AdventHealth Medical Group

  • Family Medicine Physician
  • Orlando, FL
  • NPI 1225034234

  Physician Assistant

  NPD (past)
• Florida Hospital Medical Group Inc

  dba Rothman Orthopaedics AdventHealth Medical Group at Minneola

  • Prosthetic/Orthotic Supplier
  • Minneola, FL
  • NPI 1285591545
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1462406400000",
    "number": "1013115120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3127 W HALLANDALE BEACH BLVD",
            "address_2": "#102",
            "city": "HALLANDALE",
            "state": "FL",
            "postal_code": "330095150",
            "telephone_number": "866-816-7846",
            "fax_number": "954-458-2928"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 E ALTAMONTE DR STE 210",
            "city": "ALTAMONTE SPRINGS",
            "state": "FL",
            "postal_code": "327014824",
            "telephone_number": "407-303-5452",
            "fax_number": "407-303-5448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEREDIA",
        "first_name": "MARIO",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-10",
        "last_updated": "2016-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9108764",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIO",
            "last_name": "HEREDIA BLANCO",
            "middle_name": "ALFREDO",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Lorraine Luce Henry
• Tiffany Henry
• Edna Heqimi
• Her GYN, LLC
• Jasmine Herbert
• Herman and Associates
• Ernesto Hernandez Krepishov
• Sonia Hernandez Suarez
• Anna M Herpin, CMBC
• Starlyn Herrera

• Physician Assistant in Altamonte Springs, FL
• Providers in Altamonte Springs, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.