Provider Demographics
NPI:1952178675
Name:MARYSSA HERNANDEZ LLC
Entity Type:Organization
Organization Name:MARYSSA HERNANDEZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:CD, PCD, CCED, LEC
Authorized Official - Phone:818-857-2960
Mailing Address - Street 1:492 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-2207
Mailing Address - Country:US
Mailing Address - Phone:818-857-2960
Mailing Address - Fax:
Practice Address - Street 1:492 MONROE ST
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2207
Practice Address - Country:US
Practice Address - Phone:818-857-2960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty