Healthcare Provider Details

I. General information

NPI: 1013858943
Provider Name (Legal Business Name): LUIS ANGEL HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 04/03/2026
Certification Date: 03/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 N 84TH AVE
PHOENIX AZ
85037-1831
US

IV. Provider business mailing address

945 N. CENTRAL WOODMERE, NY 11598
WOODMERE NY
11598
US

V. Phone/Fax

Practice location:
  • Phone: 623-418-9670
  • Fax:
Mailing address:
  • Phone: 623-418-9670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: