Provider Demographics
NPI:1518206663
Name:HERNANDEZ, MIRYAM (BA)
Entity Type:Individual
Prefix:
First Name:MIRYAM
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4325 NW 116TH AVE
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-4230
Mailing Address - Country:US
Mailing Address - Phone:786-597-6772
Mailing Address - Fax:
Practice Address - Street 1:4325 NW 116TH AVE
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-4230
Practice Address - Country:US
Practice Address - Phone:786-597-6772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-10
Last Update Date:2013-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker