Provider Demographics
NPI:1023567971
Name:HERNANDEZ, DAYANARA SARAHI (OTA)
Entity Type:Individual
Prefix:
First Name:DAYANARA
Middle Name:SARAHI
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 JUNE ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-3240
Mailing Address - Country:US
Mailing Address - Phone:505-903-8096
Mailing Address - Fax:
Practice Address - Street 1:5901 OURAY RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-1381
Practice Address - Country:US
Practice Address - Phone:505-836-0023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant