Provider Demographics
NPI:1194583252
Name:YERVILLA HERNANDEZ, ISRAEL I
Entity type:Individual
Prefix:
First Name:ISRAEL
Middle Name:
Last Name:YERVILLA HERNANDEZ
Suffix:I
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 1:1401 SW 134TH WAY APT 210
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1859
Mailing Address - Country:US
Mailing Address - Phone:954-218-9505
Mailing Address - Fax:
Practice Address - Street 1:3 SW 129TH AVE STE 203
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1779
Practice Address - Country:US
Practice Address - Phone:954-589-2539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician