Provider Demographics
NPI:1487841052
Name:HERNANDEZ, MARIA CONSUELO (DC)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:CONSUELO
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6225 GANNETDALE DR
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-4823
Mailing Address - Country:US
Mailing Address - Phone:813-335-9605
Mailing Address - Fax:
Practice Address - Street 1:716 S OAKWOOD AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6124
Practice Address - Country:US
Practice Address - Phone:813-999-2008
Practice Address - Fax:813-995-0558
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH 10452111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor