Provider Demographics
NPI:1578826533
Name:HERNANDEZ, MARIBELLE (MARIBELLE HERNANDEZ)
Entity type:Individual
Prefix:MS
First Name:MARIBELLE
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MARIBELLE HERNANDEZ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 PELHAM PKWY S APT F15
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-1106
Mailing Address - Country:US
Mailing Address - Phone:917-312-4742
Mailing Address - Fax:
Practice Address - Street 1:780 PELHAM PKWY S APT F15
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-1106
Practice Address - Country:US
Practice Address - Phone:917-312-4742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-24
Last Update Date:2012-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY26240174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist