Healthcare Provider Details

I. General information

NPI: 1750872370
Provider Name (Legal Business Name): MARUQUEL J HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 SW 9TH AVE
BOCA RATON FL
33486-5449
US

IV. Provider business mailing address

841 SW 9TH AVE
BOCA RATON FL
33486-5449
US

V. Phone/Fax

Practice location:
  • Phone: 561-291-3691
  • Fax:
Mailing address:
  • Phone: 561-291-3691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number81-1644373
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: