Healthcare Provider Details

I. General information

NPI: 1538638929
Provider Name (Legal Business Name): LIAMARELIS HURTADO HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2018
Last Update Date: 11/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6918 N HUBERT AVE
TAMPA FL
33614-3835
US

IV. Provider business mailing address

6918 N HUBERT AVE
TAMPA FL
33614-3835
US

V. Phone/Fax

Practice location:
  • Phone: 813-778-8331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: