Provider Demographics
NPI:1679020291
Name:HERNANDEZ, NIURKA I
Entity Type:Individual
Prefix:
First Name:NIURKA
Middle Name:
Last Name:HERNANDEZ
Suffix:I
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 1:530 W 36TH PL
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-5142
Mailing Address - Country:US
Mailing Address - Phone:786-606-7351
Mailing Address - Fax:786-558-8629
Practice Address - Street 1:530 W 36TH PL
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5142
Practice Address - Country:US
Practice Address - Phone:786-606-7351
Practice Address - Fax:786-558-8629
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15-10591106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician