Provider Demographics
NPI:1003212226
Name:HERNANDEZ-CASABLANCA, ANA M
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:M
Last Name:HERNANDEZ-CASABLANCA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6914 MAIN ST
Mailing Address - Street 2:APT. 264
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-7011
Mailing Address - Country:US
Mailing Address - Phone:787-344-0196
Mailing Address - Fax:
Practice Address - Street 1:6914 MAIN ST
Practice Address - Street 2:APT. 264
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-7011
Practice Address - Country:US
Practice Address - Phone:787-344-0196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-16
Last Update Date:2014-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9253595174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist