Provider Demographics
NPI:1649828237
Name:HERNANDEZ DANIEL, BLANCA HERNANDEZ
Entity type:Individual
Prefix:
First Name:BLANCA
Middle Name:HERNANDEZ
Last Name:HERNANDEZ DANIEL
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 1:17770 SW 107TH AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-0823
Mailing Address - Country:US
Mailing Address - Phone:786-478-2467
Mailing Address - Fax:
Practice Address - Street 1:17770 SW 107TH AVE APT 201
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-0823
Practice Address - Country:US
Practice Address - Phone:786-478-2467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-19-82176106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician