Provider Demographics
NPI:1699037556
Name:HERNANDEZ-VILA, ANA LYDIA (SERVICE COORDINATOR)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:LYDIA
Last Name:HERNANDEZ-VILA
Suffix:
Gender:F
Credentials:SERVICE COORDINATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 LACONIA AVE # 2
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-1417
Mailing Address - Country:US
Mailing Address - Phone:917-349-9237
Mailing Address - Fax:347-843-8005
Practice Address - Street 1:22018 HORACE HARDING EXPY
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11364-2227
Practice Address - Country:US
Practice Address - Phone:718-423-0056
Practice Address - Fax:718-229-5370
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator