Provider Demographics
NPI:1598466211
Name:HERNANDEZ FERNANDEZ, MACIEL
Entity Type:Individual
Prefix:
First Name:MACIEL
Middle Name:
Last Name:HERNANDEZ FERNANDEZ
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 1:2001 GOLDENDALE CT
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-2300
Mailing Address - Country:US
Mailing Address - Phone:540-598-7427
Mailing Address - Fax:
Practice Address - Street 1:2001 GOLDENDALE CT
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-2300
Practice Address - Country:US
Practice Address - Phone:540-598-7427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician