Provider Demographics
NPI:1558191882
Name:ALVAREZ HERNANDEZ, DALLANA
Entity type:Individual
Prefix:
First Name:DALLANA
Middle Name:
Last Name:ALVAREZ 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 1:1418 DESOTO AVE
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33972-8533
Mailing Address - Country:US
Mailing Address - Phone:239-691-9722
Mailing Address - Fax:
Practice Address - Street 1:1418 DESOTO AVE
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33972-8533
Practice Address - Country:US
Practice Address - Phone:239-691-9722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-362186106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician