Provider Demographics
NPI:1477363869
Name:AVILAS HERNANDEZ, DANIELA B
Entity type:Individual
Prefix:
First Name:DANIELA
Middle Name:B
Last Name:AVILAS 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 1:10054 MEADOWRUN DR
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-2878
Mailing Address - Country:US
Mailing Address - Phone:813-407-7275
Mailing Address - Fax:813-521-7415
Practice Address - Street 1:213 N PARSONS AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4513
Practice Address - Country:US
Practice Address - Phone:813-407-7275
Practice Address - Fax:813-521-7415
Is Sole Proprietor?:No
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-401940106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician