1306038005 NPI number — DR. RENE HERNANDEZ CARDENACHE PSY.D., M.S.ED.

Table of content: DR. RENE HERNANDEZ CARDENACHE PSY.D., M.S.ED. (NPI 1306038005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306038005 NPI number — DR. RENE HERNANDEZ CARDENACHE PSY.D., M.S.ED.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERNANDEZ CARDENACHE
Provider First Name:
RENE
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D., M.S.ED.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306038005
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3225 AVIATION AVE
Provider Second Line Business Mailing Address:
SUITE 303
Provider Business Mailing Address City Name:
COCONUT GROVE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33133-4741
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-243-4060
Provider Business Mailing Address Fax Number:
305-243-4061

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3225 AVIATION AVE
Provider Second Line Business Practice Location Address:
SUITE 303
Provider Business Practice Location Address City Name:
COCONUT GROVE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33133-4741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-243-4060
Provider Business Practice Location Address Fax Number:
305-243-4061
Provider Enumeration Date:
08/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 005592400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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