Provider Demographics
NPI:1770081580
Name:HERNANDEZ LAFARGUE, DAHINA
Entity type:Individual
Prefix:
First Name:DAHINA
Middle Name:
Last Name:HERNANDEZ LAFARGUE
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 1:14233 SW 47TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-4326
Mailing Address - Country:US
Mailing Address - Phone:786-675-1228
Mailing Address - Fax:
Practice Address - Street 1:142 CYPRESS TRCE
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-4707
Practice Address - Country:US
Practice Address - Phone:855-832-6727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-26
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-18-50214106S00000X
FL295081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician