Provider Demographics
NPI:1609753219
Name:HERNANDEZ, EDUARDO (CCSH)
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:CCSH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 PORT ST JOHN PKWY
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT JOHN
Mailing Address - State:FL
Mailing Address - Zip Code:32927-4305
Mailing Address - Country:US
Mailing Address - Phone:213-268-6408
Mailing Address - Fax:
Practice Address - Street 1:5005 PORT ST JOHN PKWY
Practice Address - Street 2:
Practice Address - City:PORT SAINT JOHN
Practice Address - State:FL
Practice Address - Zip Code:32927-4305
Practice Address - Country:US
Practice Address - Phone:321-268-6408
Practice Address - Fax:321-268-6214
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator