Provider Demographics
NPI:1538635073
Name:HERNANDEZ, ARISTIDES (MA)
Entity Type:Individual
Prefix:
First Name:ARISTIDES
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 W CYPRESS CREEK RD STE 243
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1713
Mailing Address - Country:US
Mailing Address - Phone:305-785-4697
Mailing Address - Fax:
Practice Address - Street 1:1260 SW 4TH ST APT 3
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2408
Practice Address - Country:US
Practice Address - Phone:305-785-4697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-23
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL82931225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty