Provider Demographics
NPI:1164160768
Name:HERNANDEZ MAYORGA, LINDA
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:HERNANDEZ MAYORGA
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 1:203 SOUTHBRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-8458
Mailing Address - Country:US
Mailing Address - Phone:863-317-9764
Mailing Address - Fax:
Practice Address - Street 1:618 N MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5262
Practice Address - Country:US
Practice Address - Phone:407-343-6006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program