Provider Demographics
NPI:1154046258
Name:HERNANDEZ TASE, MAYLIN
Entity type:Individual
Prefix:
First Name:MAYLIN
Middle Name:
Last Name:HERNANDEZ TASE
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 1:245 NE 14TH ST APT 3315
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33132-1636
Mailing Address - Country:US
Mailing Address - Phone:786-658-7098
Mailing Address - Fax:
Practice Address - Street 1:245 NE 14TH ST APT 3315
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-1636
Practice Address - Country:US
Practice Address - Phone:786-658-7098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician