Provider Demographics
NPI:1225860315
Name:HERNANDEZ HERNANDEZ, JERBYS YOAN
Entity type:Individual
Prefix:
First Name:JERBYS
Middle Name:YOAN
Last Name:HERNANDEZ 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 1:8105 SW 206TH TER
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-2624
Mailing Address - Country:US
Mailing Address - Phone:786-210-8883
Mailing Address - Fax:
Practice Address - Street 1:8105 SW 206TH TER
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-2624
Practice Address - Country:US
Practice Address - Phone:786-210-8883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-369500106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician