Healthcare Provider Details

I. General information

NPI: 1295496560
Provider Name (Legal Business Name): ELIOFRANK HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2022
Last Update Date: 01/12/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 QUEEN ALEXANDRIA DR
KISSIMMEE FL
34744-9108
US

IV. Provider business mailing address

3100 QUEEN ALEXANDRIA DR
KISSIMMEE FL
34744-9108
US

V. Phone/Fax

Practice location:
  • Phone: 407-508-6603
  • Fax:
Mailing address:
  • Phone: 407-508-6603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: