Provider Demographics
NPI:1457569899
Name:HERNANDEZ, CELSA IDA
Entity Type:Individual
Prefix:
First Name:CELSA
Middle Name:IDA
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 1:42 HANCOCK ST
Mailing Address - Street 2:APT. 1
Mailing Address - City:CHELSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02150-1210
Mailing Address - Country:US
Mailing Address - Phone:617-884-5128
Mailing Address - Fax:
Practice Address - Street 1:530 BORDER ST
Practice Address - Street 2:
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-2432
Practice Address - Country:US
Practice Address - Phone:161-756-9650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator