Provider Demographics
NPI:1235633678
Name:HERNANDEZ, IRINA I
Entity Type:Individual
Prefix:MS
First Name:IRINA
Middle Name:
Last Name:HERNANDEZ
Suffix:I
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 1:5415 NW 192ND LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-6173
Mailing Address - Country:US
Mailing Address - Phone:786-263-8392
Mailing Address - Fax:
Practice Address - Street 1:14505 COMMERCE WAY
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1597
Practice Address - Country:US
Practice Address - Phone:786-332-5970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician