Provider Demographics
NPI:1720249576
Name:HERNANDEZ, HEATHER J (PHD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:J
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1390 S DIXIE HWY
Mailing Address - Street 2:SUITE 1305
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2927
Mailing Address - Country:US
Mailing Address - Phone:305-936-1002
Mailing Address - Fax:
Practice Address - Street 1:1390 S DIXIE HWY
Practice Address - Street 2:SUITE 1305
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2927
Practice Address - Country:US
Practice Address - Phone:305-936-1002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7724103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical