Provider Demographics
NPI:1245723014
Name:HERNANDEZ, MARITZA (LVN)
Entity type:Individual
Prefix:
First Name:MARITZA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 NESSUH AVE
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541-4814
Mailing Address - Country:US
Mailing Address - Phone:956-630-1116
Mailing Address - Fax:877-626-0431
Practice Address - Street 1:2025 S 40TH ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-8467
Practice Address - Country:US
Practice Address - Phone:956-878-9676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX181535164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse