Provider Demographics
NPI:1902378276
Name:HERNANDEZ, DORALKYS DE LAS MERCEDES
Entity Type:Individual
Prefix:
First Name:DORALKYS
Middle Name:DE LAS MERCEDES
Last Name: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 1:14335 SW 120TH ST STE 112
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7295
Mailing Address - Country:US
Mailing Address - Phone:305-554-4111
Mailing Address - Fax:
Practice Address - Street 1:14335 SW 120TH ST STE 112
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7295
Practice Address - Country:US
Practice Address - Phone:305-554-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician