Healthcare Provider Details

I. General information

NPI: 1871141069
Provider Name (Legal Business Name): MARTHA M HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2019
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2977 GOODLETTE-FRANK RD N STE 14
NAPLES FL
34103-4613
US

IV. Provider business mailing address

15900 SW 197TH AVE
MIAMI FL
33187-1108
US

V. Phone/Fax

Practice location:
  • Phone: 786-468-1087
  • Fax:
Mailing address:
  • Phone: 786-468-1087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: