Provider Demographics
NPI:1699390120
Name:DUARTE HERNANDEZ, ELIER
Entity Type:Individual
Prefix:
First Name:ELIER
Middle Name:
Last Name:DUARTE HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10726 SW 148TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-3396
Mailing Address - Country:US
Mailing Address - Phone:786-227-0559
Mailing Address - Fax:
Practice Address - Street 1:12150 SW 128TH CT STE 222
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4674
Practice Address - Country:US
Practice Address - Phone:786-701-8164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
20-118930106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician