Provider Demographics
NPI:1659933224
Name:HERNANDEZ IZQUIERDO, DIANELYS
Entity Type:Individual
Prefix:
First Name:DIANELYS
Middle Name:
Last Name:HERNANDEZ IZQUIERDO
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 1:8501 SW 209TH LN
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-3310
Mailing Address - Country:US
Mailing Address - Phone:786-303-0936
Mailing Address - Fax:
Practice Address - Street 1:8501 SW 209TH LN
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-3310
Practice Address - Country:US
Practice Address - Phone:786-303-0936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-03
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X, 106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician