Provider Demographics
NPI:1134764988
Name:MONTES HERNANDEZ, MAYLLELIN OFELIA
Entity type:Individual
Prefix:
First Name:MAYLLELIN
Middle Name:OFELIA
Last Name:MONTES 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 1:1840 W 49TH ST STE 222
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2949
Mailing Address - Country:US
Mailing Address - Phone:305-310-0352
Mailing Address - Fax:
Practice Address - Street 1:1840 W 49TH ST STE 222
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2949
Practice Address - Country:US
Practice Address - Phone:305-310-0352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker