Healthcare Provider Details

I. General information

NPI: 1134007826
Provider Name (Legal Business Name): CARLOS HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 08/24/2025
Certification Date: 08/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11025 SW 84TH ST STE 8
MIAMI FL
33173-3856
US

IV. Provider business mailing address

8395 SW 73RD AVE APT 406
MIAMI FL
33143-7527
US

V. Phone/Fax

Practice location:
  • Phone: 305-971-1230
  • Fax:
Mailing address:
  • Phone: 305-496-6422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: