Provider Demographics
NPI:1871000901
Name:HERNANDEZ SOTO, ANA M
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:M
Last Name:HERNANDEZ SOTO
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 1:4861 NW 192ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-2056
Mailing Address - Country:US
Mailing Address - Phone:786-585-3407
Mailing Address - Fax:
Practice Address - Street 1:4861 NW 192ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-2056
Practice Address - Country:US
Practice Address - Phone:786-585-3407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician