Provider Demographics
NPI:1841786902
Name:HERNANDEZ, OLGA MARTA
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:MARTA
Last Name: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 1:401 NW 72ND AVE APT 206
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-5820
Mailing Address - Country:US
Mailing Address - Phone:786-740-9661
Mailing Address - Fax:
Practice Address - Street 1:401 NW 72ND AVE APT 206
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5820
Practice Address - Country:US
Practice Address - Phone:786-740-9661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021147400Medicaid