Healthcare Provider Details

I. General information

NPI: 1952178675
Provider Name (Legal Business Name): MARYSSA HERNANDEZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

492 MONROE ST
MONTEREY CA
93940-2207
US

IV. Provider business mailing address

492 MONROE ST
MONTEREY CA
93940-2207
US

V. Phone/Fax

Practice location:
  • Phone: 818-857-2960
  • Fax:
Mailing address:
  • Phone: 818-857-2960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: MARYSSA HERNANDEZ
Title or Position: OWNER
Credential: CD, PCD, CCED, LEC
Phone: 818-857-2960