Provider Demographics
NPI:1144054644
Name:HERNANDEZ, BRANDEN BARBARO
Entity type:Individual
Prefix:
First Name:BRANDEN
Middle Name:BARBARO
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 1:5333 SW 75TH ST APT N84
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-7450
Mailing Address - Country:US
Mailing Address - Phone:504-373-0311
Mailing Address - Fax:
Practice Address - Street 1:5333 SW 75TH ST APT N84
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-7450
Practice Address - Country:US
Practice Address - Phone:504-373-0311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician