Provider Demographics
NPI:1285302109
Name:FERNANDEZ-GONZALEZ, HANY
Entity type:Individual
Prefix:
First Name:HANY
Middle Name:
Last Name:FERNANDEZ-GONZALEZ
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 1:8580 SW 212TH ST APT 307
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-3379
Mailing Address - Country:US
Mailing Address - Phone:305-586-9254
Mailing Address - Fax:
Practice Address - Street 1:8580 SW 212TH ST APT 307
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-3379
Practice Address - Country:US
Practice Address - Phone:305-586-9254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-20-12611106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician