Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-20-11057 | FL |
NPI | 1093203739 |
---|---|
Provider Name | Deyci Hernandez |
First Address | Hialeah, FL 33014-4013 |
Second Address | Hialeah, FL 33014-4013 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2018 |
Last Update Date | 07/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
107243300 | (05) | FL |