Healthcare Provider Details

I. General information

NPI: 1063359842
Provider Name (Legal Business Name): JESUS HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8825 NW 34TH AVENUE RD
MIAMI FL
33147-2854
US

IV. Provider business mailing address

8825 NW 34TH AVENUE RD
MIAMI FL
33147-2854
US

V. Phone/Fax

Practice location:
  • Phone: 786-520-9926
  • Fax:
Mailing address:
  • Phone: 786-520-9926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: