Provider Demographics
NPI:1659805349
Name:HERNANDEZ, ENEYDA (BS)
Entity Type:Individual
Prefix:
First Name:ENEYDA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6960 NW 186TH ST
Mailing Address - Street 2:APT-124
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3254
Mailing Address - Country:US
Mailing Address - Phone:502-296-1668
Mailing Address - Fax:
Practice Address - Street 1:6960 NW 186TH ST
Practice Address - Street 2:APT-124
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-3254
Practice Address - Country:US
Practice Address - Phone:502-296-1668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator