Provider Demographics
NPI:1720786825
Name:HERNANDEZ, BRANDON ALEXANDER
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:ALEXANDER
Last Name: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 1:12870 SW 58TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-5420
Mailing Address - Country:US
Mailing Address - Phone:786-417-9005
Mailing Address - Fax:
Practice Address - Street 1:12870 SW 58TH LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-5420
Practice Address - Country:US
Practice Address - Phone:786-417-9005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician