Provider Demographics
NPI:1295458677
Name:HERNANDEZ, MILAGRO DEJESUS
Entity type:Individual
Prefix:
First Name:MILAGRO
Middle Name:DEJESUS
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 1:2114 RUATAN ST
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-2170
Mailing Address - Country:US
Mailing Address - Phone:301-237-1390
Mailing Address - Fax:
Practice Address - Street 1:463 MADISON ST NE # NE877
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-6220
Practice Address - Country:US
Practice Address - Phone:877-659-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant