Provider Demographics
NPI:1407690613
Name:HERNANDEZ OLIVA, JIAN CARLOS
Entity type:Individual
Prefix:
First Name:JIAN
Middle Name:CARLOS
Last Name:HERNANDEZ OLIVA
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 1:38433 ALSTON AVE
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7807
Mailing Address - Country:US
Mailing Address - Phone:305-684-1996
Mailing Address - Fax:
Practice Address - Street 1:38433 ALSTON AVE
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-7807
Practice Address - Country:US
Practice Address - Phone:305-684-1996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-21
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-352716106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician