Provider Demographics
NPI:1851568984
Name:HERNANDEZ, ILEANA (MBA)
Entity Type:Individual
Prefix:
First Name:ILEANA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7801 CORAL WAY STE 115
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-6538
Mailing Address - Country:US
Mailing Address - Phone:305-266-8889
Mailing Address - Fax:305-266-8677
Practice Address - Street 1:7801 CORAL WAY STE 115
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6538
Practice Address - Country:US
Practice Address - Phone:305-266-8889
Practice Address - Fax:305-266-8677
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker