Provider Demographics
NPI:1568813053
Name:HERNANDEZ, GIANCARLO (COTA)
Entity Type:Individual
Prefix:MR
First Name:GIANCARLO
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18810 NW 77TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5241
Mailing Address - Country:US
Mailing Address - Phone:786-553-4847
Mailing Address - Fax:
Practice Address - Street 1:18810 NW 77TH CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5241
Practice Address - Country:US
Practice Address - Phone:786-553-4847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-25
Last Update Date:2016-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA15285224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant