Provider Demographics
NPI:1891368734
Name:HERNANDEZ, DAMARIS
Entity Type:Individual
Prefix:MRS
First Name:DAMARIS
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:DAMARIS
Other - Middle Name:
Other - Last Name:SANDOVAL-GOMEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1402 S GUM ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-5354
Mailing Address - Country:US
Mailing Address - Phone:503-480-5598
Mailing Address - Fax:
Practice Address - Street 1:1402 S GUM ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99337-5354
Practice Address - Country:US
Practice Address - Phone:503-480-5598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter