Healthcare Provider Details

I. General information

NPI: 1104780139
Provider Name (Legal Business Name): ROCIO DEL CARMEN HERNANDEZ VALETTE BSN-RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3332 BROADWAY
NEW YORK NY
10031-8732
US

IV. Provider business mailing address

1264 COLLEGE AVE
BRONX NY
10456-3204
US

V. Phone/Fax

Practice location:
  • Phone: 212-694-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number892205
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: