MEDICARE: MARLEN HERNANDEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0807X	Child & Adolescent Psychiatric/Mental Health Registered Nurse	20128612	FL

General Provider Information

NPI Number	:	1598464802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLEN HERNANDEZ

Provider Business Mailing Address
First Line	:	541 SW 42ND AVE APT 130
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-1967
Country	:	US
Telephone Number	:	305-401-7673
Fax Number	:

Provider Business Practice Location Address
First Line	:	541 SW 42ND AVE APT 130
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-1967
Country	:	US
Telephone Number	:	305-401-7673
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2023
Last Update Date	:	02/24/2023

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Directions to “ MARLEN HERNANDEZ ” Practice Location

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