MEDICARE: DR. DIANE HERNANDEZ PSY.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PY8625	FL

General Provider Information

NPI Number	:	1033419874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANE HERNANDEZ PSY.D

Provider Business Mailing Address
First Line	:	143 MIRAMAR AVE
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-1162
Country	:	US
Telephone Number	:	954-701-0418
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 HARVARD CIR
Second Line	:	SUITE 109
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-1979
Country	:	US
Telephone Number	:	954-701-0418
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2010
Last Update Date	:	03/16/2017

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