Provider Demographics
NPI:1952924102
Name:HERNANDEZ BERMUDEZ, YANET ALIUSKA
Entity Type:Individual
Prefix:
First Name:YANET
Middle Name:ALIUSKA
Last Name:HERNANDEZ BERMUDEZ
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 1:21386 SW 112TH AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-2951
Mailing Address - Country:US
Mailing Address - Phone:786-379-1289
Mailing Address - Fax:
Practice Address - Street 1:21386 SW 112TH AVE APT 201
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-2951
Practice Address - Country:US
Practice Address - Phone:786-379-1289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-22
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-119374106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician