Provider Demographics
NPI:1356172118
Name:HERNANDEZ LOPEZ, MAGELA
Entity type:Individual
Prefix:
First Name:MAGELA
Middle Name:
Last Name:HERNANDEZ LOPEZ
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 1:1806 ABBEY RD APT 107D
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-9156
Mailing Address - Country:US
Mailing Address - Phone:561-704-6964
Mailing Address - Fax:
Practice Address - Street 1:1806 ABBEY RD APT 107D
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-9156
Practice Address - Country:US
Practice Address - Phone:561-704-6964
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician