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General NPI Number Information
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NPI Number | 1134631070
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Entity Type | Individual
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Provider Name | ODALYS HERNANDEZ CCM
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Gender | Female
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Dates
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Enumeration Date | 11/01/2017
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Last Update Date | 10/04/2025
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Provider Practice Location Address
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Address Line | 3271 NW 7TH ST STE 203
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City | MIAMI
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State | FL
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Zip | 33125-4141
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Country | US
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Telephone | 786-220-6902
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Fax | 866-726-0526
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Provider Business Mailing Address
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Address Line | 9686 FONTAINEBLEAU BLVD APT 504
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City | MIAMI
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State | FL
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Zip | 33172-4136
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Country | US
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Telephone | 786-800-4552
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-18-74552
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | CCM100323
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2781
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License Number State | PR
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