Provider Demographics
NPI:1851776322
Name:HERNANDEZ, ULICE A (MD ED)
Entity Type:Individual
Prefix:
First Name:ULICE
Middle Name:A
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6169 METROWEST BLVD UNIT 108
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-2998
Mailing Address - Country:US
Mailing Address - Phone:407-952-8633
Mailing Address - Fax:
Practice Address - Street 1:6169 METROWEST BLVD UNIT 108
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-2998
Practice Address - Country:US
Practice Address - Phone:407-952-8633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health