Provider Demographics
NPI:1427804558
Name:FERNANDEZ HERRERA, YAIMY
Entity type:Individual
Prefix:
First Name:YAIMY
Middle Name:
Last Name:FERNANDEZ HERRERA
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 1:290 W 53RD ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3754
Mailing Address - Country:US
Mailing Address - Phone:786-262-9382
Mailing Address - Fax:
Practice Address - Street 1:1160 KANE CONCOURSE STE 203
Practice Address - Street 2:
Practice Address - City:BAY HARBOR ISLANDS
Practice Address - State:FL
Practice Address - Zip Code:33154-2020
Practice Address - Country:US
Practice Address - Phone:305-560-5859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH31828124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist