Provider Demographics
NPI:1801196126
Name:HERNANDEZ, ANTONIO MIGUEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:MIGUEL
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8820 SW 24TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2008
Mailing Address - Country:US
Mailing Address - Phone:305-559-8484
Mailing Address - Fax:
Practice Address - Street 1:8820 SW 24TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2008
Practice Address - Country:US
Practice Address - Phone:305-559-8484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist