Provider Demographics
NPI:1881344174
Name:HERNANDEZ FUMERO, MIRIELA
Entity type:Individual
Prefix:
First Name:MIRIELA
Middle Name:
Last Name:HERNANDEZ FUMERO
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 1:995 W 29TH ST APT 203
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-5602
Mailing Address - Country:US
Mailing Address - Phone:305-303-6573
Mailing Address - Fax:
Practice Address - Street 1:995 W 29TH ST APT 203
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5602
Practice Address - Country:US
Practice Address - Phone:305-303-6573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL113502300106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician