Provider Demographics
NPI:1912559147
Name:HERNANDEZ, CRISTINA MICHELLE (BS)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:MICHELLE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 CAPER LN APT 101
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-6013
Mailing Address - Country:US
Mailing Address - Phone:407-421-7266
Mailing Address - Fax:
Practice Address - Street 1:2521 CAPER LN APT 101
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-6013
Practice Address - Country:US
Practice Address - Phone:407-421-7266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities