Provider Demographics
NPI:1265889901
Name:HERNANDEZ RODRIGUEZ, MARIA ELVIRA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ELVIRA
Last Name:HERNANDEZ RODRIGUEZ
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 1:8993 SW 9TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-3243
Mailing Address - Country:US
Mailing Address - Phone:786-344-9630
Mailing Address - Fax:
Practice Address - Street 1:8993 SW 9TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-3243
Practice Address - Country:US
Practice Address - Phone:786-344-9630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-23
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-15-03783106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician