Provider Demographics
NPI:1548819949
Name:HERNANDEZ, CRYSTAL (SLP)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11241 SW 129TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4764
Mailing Address - Country:US
Mailing Address - Phone:305-519-5026
Mailing Address - Fax:
Practice Address - Street 1:STARS CENTER FOR SPEECH THERAPY & RELATED SERVICES LLC
Practice Address - Street 2:12030 SW 129TH CT #209
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186
Practice Address - Country:US
Practice Address - Phone:786-429-3619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ9327390200000X
FLSA18394261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program