Provider Demographics
NPI:1801197207
Name:HERNANDEZ, YANET
Entity Type:Individual
Prefix:MS
First Name:YANET
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:LAZARO
Other - Middle Name:DAVID
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:H655960868040
Mailing Address - Street 1:4000 SOUTH 57TH
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463
Mailing Address - Country:US
Mailing Address - Phone:561-649-7881
Mailing Address - Fax:561-649-7528
Practice Address - Street 1:4000 SOUTH 57TH
Practice Address - Street 2:SUITE 202
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463
Practice Address - Country:US
Practice Address - Phone:561-649-7881
Practice Address - Fax:561-649-7528
Is Sole Proprietor?:No
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM25686111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMM25686OtherID