Provider Demographics
NPI:1083850895
Name:HERNANDEZ, CARLOS A
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:A
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 PEABODY HALL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32611-4100
Mailing Address - Country:US
Mailing Address - Phone:352-514-1203
Mailing Address - Fax:352-392-8452
Practice Address - Street 1:301 PEABODY HALL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32611-4100
Practice Address - Country:US
Practice Address - Phone:352-514-1203
Practice Address - Fax:352-392-8452
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 0002943101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health