Provider Demographics
NPI:1649747783
Name:HERNANDEZ, RITA HILARI (HS)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:HILARI
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:HS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 68TH ST SW
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49548-7179
Mailing Address - Country:US
Mailing Address - Phone:616-202-5161
Mailing Address - Fax:248-712-4381
Practice Address - Street 1:346 68TH ST SW
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49548-7179
Practice Address - Country:US
Practice Address - Phone:616-202-5161
Practice Address - Fax:248-712-4381
Is Sole Proprietor?:No
Enumeration Date:2018-10-26
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No156F00000XEye and Vision Services ProvidersTechnician/Technologist