Provider Demographics
NPI:1790907350
Name:LEVIN DE HERNANDEZ, MARIA DE LOURDES
Entity Type:Individual
Prefix:MRS
First Name:MARIA DE LOURDES
Middle Name:
Last Name:LEVIN DE 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 1:1246 3RD AVE APT 10
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-3200
Mailing Address - Country:US
Mailing Address - Phone:619-422-5399
Mailing Address - Fax:
Practice Address - Street 1:5005 TEXAS ST.,
Practice Address - Street 2:203
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3721
Practice Address - Country:US
Practice Address - Phone:619-692-0727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator