Provider Demographics
NPI:1922622083
Name:PEREZ HERNANDEZ, YAINE
Entity Type:Individual
Prefix:
First Name:YAINE
Middle Name:
Last Name:PEREZ 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 1:5930 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-5155
Mailing Address - Country:US
Mailing Address - Phone:305-713-6219
Mailing Address - Fax:
Practice Address - Street 1:5930 GARFIELD ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5155
Practice Address - Country:US
Practice Address - Phone:305-713-6219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician