Provider Demographics
NPI:1063969335
Name:HERNANDEZ, LUCIA
Entity type:Individual
Prefix:
First Name:LUCIA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W 140TH ST APT 6E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-6139
Mailing Address - Country:US
Mailing Address - Phone:787-648-6584
Mailing Address - Fax:
Practice Address - Street 1:28 DEBEVOISE ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-4102
Practice Address - Country:US
Practice Address - Phone:718-963-4430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-05
Last Update Date:2016-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker