Provider Demographics
NPI:1851008825
Name:HERNANDEZ, MARIA KARLA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:KARLA
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 1:3641 SW 22ND ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-4245
Mailing Address - Country:US
Mailing Address - Phone:786-426-4497
Mailing Address - Fax:
Practice Address - Street 1:3641 SW 22ND ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-4245
Practice Address - Country:US
Practice Address - Phone:786-426-4497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician