Healthcare Provider Details

I. General information

NPI: 1982140919
Provider Name (Legal Business Name): ADIS MESA HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2017
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7010 SW 9TH ST
PEMBROKE PINES FL
33023-1639
US

IV. Provider business mailing address

7010 SW 9TH ST
PEMBROKE PINES FL
33023-1639
US

V. Phone/Fax

Practice location:
  • Phone: 786-531-8431
  • Fax:
Mailing address:
  • Phone: 786-531-8431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCBA-1-20-44207
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: