Provider Demographics
NPI:1346968484
Name:HERNANDEZ, MAILENI
Entity Type:Individual
Prefix:
First Name:MAILENI
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 1:767 A AND V THIELEMANN AVE
Mailing Address - Street 2:
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231-3615
Mailing Address - Country:US
Mailing Address - Phone:760-427-0898
Mailing Address - Fax:
Practice Address - Street 1:767 A AND V THIELEMANN AVE
Practice Address - Street 2:
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-3615
Practice Address - Country:US
Practice Address - Phone:760-427-0898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst