Provider Demographics
NPI:1851814537
Name:HERNANDEZ, YVETTE NAOMI (LAC)
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:NAOMI
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 NE 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-2208
Mailing Address - Country:US
Mailing Address - Phone:954-304-4752
Mailing Address - Fax:
Practice Address - Street 1:2530 NE 15TH AVE
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1310
Practice Address - Country:US
Practice Address - Phone:954-304-4752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-25
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3851171100000X
FLAP3851171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist