Healthcare Provider Details

I. General information

NPI: 1891241733
Provider Name (Legal Business Name): IDANIA HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 08/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4417 E COLONIAL DR
ORLANDO FL
32804-5219
US

IV. Provider business mailing address

4417 E COLONIAL DR
ORLANDO FL
32804-5219
US

V. Phone/Fax

Practice location:
  • Phone: 407-757-0785
  • Fax: 407-757-0786
Mailing address:
  • Phone: 407-757-0785
  • Fax: 407-757-0786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: