Provider Demographics
NPI:1093546558
Name:MUSTAFAT HERNANDEZ, LUIS CESAR
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:CESAR
Last Name:MUSTAFAT HERNANDEZ
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 1:5522 NW 101ST CT
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2642
Mailing Address - Country:US
Mailing Address - Phone:305-561-0714
Mailing Address - Fax:
Practice Address - Street 1:5522 NW 101ST CT
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2642
Practice Address - Country:US
Practice Address - Phone:305-561-0714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician