Basic Information
| Provider Information | |||||||||
| NPI: | 1336480664 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERNANDEZ | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | ISABEL | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 9210 88TH AVE | ||||||||
| Address2: | APT 1 | ||||||||
| City: | WOODHAVEN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114212133 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188473567 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 13303 JAMAICA AVE | ||||||||
| Address2: | |||||||||
| City: | RICHMOND HILL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114182618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182913276 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2013 | ||||||||
| LastUpdateDate: | 03/12/2013 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | F421092-1 | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.