Provider Demographics
NPI:1982290334
Name:HERNANDEZ, GLORIA VANESA
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:VANESA
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 1:9530 WILLIAM KIRK LN
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-4268
Mailing Address - Country:US
Mailing Address - Phone:571-364-9928
Mailing Address - Fax:
Practice Address - Street 1:9530 WILLIAM KIRK LN
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-4268
Practice Address - Country:US
Practice Address - Phone:571-364-9928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program