Healthcare Provider Details

I. General information

NPI: 1689283533
Provider Name (Legal Business Name): MS. ODALIS VICTORIA HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 SW 8TH ST
MIAMI FL
33144-4055
US

IV. Provider business mailing address

8500 SW 8TH ST
MIAMI FL
33144-4055
US

V. Phone/Fax

Practice location:
  • Phone: 305-909-4872
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: