Provider Demographics
NPI:1790269132
Name:NINO HERNANDEZ, MARIA E
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:E
Last Name:NINO HERNANDEZ
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 1:7575 W FLAGLER ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2467
Mailing Address - Country:US
Mailing Address - Phone:305-377-3297
Mailing Address - Fax:305-377-3854
Practice Address - Street 1:7575 W FLAGLER ST STE 200
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2467
Practice Address - Country:US
Practice Address - Phone:305-377-3297
Practice Address - Fax:305-377-3854
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCM100074171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator