Provider Demographics
NPI:1265172910
Name:HERNANDEZ, LUISA MARIA (RDN, LDN)
Entity type:Individual
Prefix:MISS
First Name:LUISA
Middle Name:MARIA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 NE 2ND AVE APT 1512
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-2912
Mailing Address - Country:US
Mailing Address - Phone:787-485-1575
Mailing Address - Fax:
Practice Address - Street 1:133 NE 2ND AVE APT 1512
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-2912
Practice Address - Country:US
Practice Address - Phone:787-485-1575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86114321133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered