Provider Demographics
NPI:1780436881
Name:HERNANDEZ CHINEA, KEVIN R
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:R
Last Name:HERNANDEZ CHINEA
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 1:10571 SW 56TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-2861
Mailing Address - Country:US
Mailing Address - Phone:786-820-0079
Mailing Address - Fax:
Practice Address - Street 1:10571 SW 56TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-2861
Practice Address - Country:US
Practice Address - Phone:786-820-0079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-315917106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty