Provider Demographics
NPI:1912558404
Name:HERNANDEZ AVILA, ANNALIE
Entity type:Individual
Prefix:
First Name:ANNALIE
Middle Name:
Last Name:HERNANDEZ AVILA
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 1:15925 NW 27TH PL
Mailing Address - Street 2:
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33054-6813
Mailing Address - Country:US
Mailing Address - Phone:786-867-0662
Mailing Address - Fax:
Practice Address - Street 1:15925 NW 27TH PL
Practice Address - Street 2:
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33054-6813
Practice Address - Country:US
Practice Address - Phone:786-867-0662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-25-82405103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty