Provider Demographics
NPI:1114693728
Name:HERNANDEZ, MARITZA
Entity Type:Individual
Prefix:
First Name:MARITZA
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 1:1818 FANNIN SPEEDWAY APT 1355
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77045-5058
Mailing Address - Country:US
Mailing Address - Phone:362-332-9890
Mailing Address - Fax:
Practice Address - Street 1:7457 HARWIN DR STE 170
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-2025
Practice Address - Country:US
Practice Address - Phone:713-429-5114
Practice Address - Fax:888-381-3767
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator