Provider Demographics
NPI:1407628910
Name:HERNANDEZ ESTENOZ, LISIANET
Entity Type:Individual
Prefix:
First Name:LISIANET
Middle Name:
Last Name:HERNANDEZ ESTENOZ
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 1:3301 E 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3203
Mailing Address - Country:US
Mailing Address - Phone:786-587-2624
Mailing Address - Fax:
Practice Address - Street 1:4236 W 16TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7624
Practice Address - Country:US
Practice Address - Phone:786-409-2646
Practice Address - Fax:786-953-6553
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB1000481106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician