Healthcare Provider Details

I. General information

NPI: 1447071121
Provider Name (Legal Business Name): HENRY ESCANDELL HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19783 NW 52ND PL
MIAMI GARDENS FL
33055-1695
US

IV. Provider business mailing address

19783 NW 52ND PL
MIAMI GARDENS FL
33055-1695
US

V. Phone/Fax

Practice location:
  • Phone: 786-561-9216
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number24-356539
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: