Provider Demographics
NPI:1982468013
Name:HERNADEZ, LEGNA
Entity Type:Individual
Prefix:
First Name:LEGNA
Middle Name:
Last Name:HERNADEZ
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 1:3321 NW 22ND AVE APT 20
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-5477
Mailing Address - Country:US
Mailing Address - Phone:786-817-3570
Mailing Address - Fax:
Practice Address - Street 1:3321 NW 22ND AVE APT 20
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-5477
Practice Address - Country:US
Practice Address - Phone:786-817-3570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-315311106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty