Provider Demographics
NPI:1194180679
Name:HERNANDEZ, ANNETTE MARIE
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:MARIE
Last Name:HERNANDEZ
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 1:3142 SW 144TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-7453
Mailing Address - Country:US
Mailing Address - Phone:305-812-8490
Mailing Address - Fax:305-383-2881
Practice Address - Street 1:3142 SW 144TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-7453
Practice Address - Country:US
Practice Address - Phone:305-812-8490
Practice Address - Fax:305-383-2881
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-28
Last Update Date:2017-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator