Provider Demographics
NPI:1023707833
Name:HERNANDEZ, CHRISTINA RAQUEL
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:RAQUEL
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 1:218 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-3712
Mailing Address - Country:US
Mailing Address - Phone:216-258-5888
Mailing Address - Fax:
Practice Address - Street 1:2936 W 17TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-5243
Practice Address - Country:US
Practice Address - Phone:216-258-5888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
Yes374U00000XNursing Service Related ProvidersHome Health Aide