Provider Demographics
NPI:1356018097
Name:HERNANDEZ HERNANDEZ, ALFREDO (BCABA)
Entity Type:Individual
Prefix:
First Name:ALFREDO
Middle Name:
Last Name:HERNANDEZ HERNANDEZ
Suffix:
Gender:M
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8145 NW 7TH ST APT 519
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-8007
Mailing Address - Country:US
Mailing Address - Phone:786-286-2438
Mailing Address - Fax:
Practice Address - Street 1:8145 NW 7TH ST APT 519
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-8007
Practice Address - Country:US
Practice Address - Phone:786-286-2438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-29
Last Update Date:2021-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-20-10837106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Single Specialty