Provider Demographics
NPI:1801384177
Name:ONDARZA HERNANDEZ, ISYANIA
Entity Type:Individual
Prefix:
First Name:ISYANIA
Middle Name:
Last Name:ONDARZA HERNANDEZ
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 1:531 NW 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-4441
Mailing Address - Country:US
Mailing Address - Phone:786-915-1829
Mailing Address - Fax:
Practice Address - Street 1:531 NW 25TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-4441
Practice Address - Country:US
Practice Address - Phone:786-915-1829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCM103967171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator