Provider Demographics
NPI:1205459542
Name:HERNANDEZ GONZALEZ, YANDILIER
Entity type:Individual
Prefix:
First Name:YANDILIER
Middle Name:
Last Name:HERNANDEZ GONZALEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20122 NW 12TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-2716
Mailing Address - Country:US
Mailing Address - Phone:270-746-4003
Mailing Address - Fax:
Practice Address - Street 1:20122 NW 12TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-2716
Practice Address - Country:US
Practice Address - Phone:270-746-4003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty