Provider Demographics
NPI:1407437726
Name:HERNANDEZ VILLANUEVA, ILENN NICOLLE
Entity Type:Individual
Prefix:
First Name:ILENN
Middle Name:NICOLLE
Last Name:HERNANDEZ VILLANUEVA
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 1:1570 SW 101ST TER
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-5010
Mailing Address - Country:US
Mailing Address - Phone:954-661-9563
Mailing Address - Fax:
Practice Address - Street 1:1570 SW 101ST TER
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-5010
Practice Address - Country:US
Practice Address - Phone:954-661-9563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst