Provider Demographics
NPI:1043074545
Name:HERNANDEZ, NATHALIA
Entity Type:Individual
Prefix:
First Name:NATHALIA
Middle Name:
Last Name:HERNANDEZ
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 1:4338 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-2716
Mailing Address - Country:US
Mailing Address - Phone:203-520-7245
Mailing Address - Fax:
Practice Address - Street 1:3601 NW 107TH AVE FL 3
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-4377
Practice Address - Country:US
Practice Address - Phone:305-418-7771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program