Provider Demographics
NPI:1316470925
Name:HERNANDEZ CARBALLO, JANE EYVIS
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:EYVIS
Last Name:HERNANDEZ CARBALLO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11951 SW 4TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-1614
Mailing Address - Country:US
Mailing Address - Phone:305-764-9238
Mailing Address - Fax:
Practice Address - Street 1:11951 SW 4TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-1614
Practice Address - Country:US
Practice Address - Phone:305-764-9238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-10
Last Update Date:2025-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLH655445845560106S00000X
FL1-22-57658103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician