Provider Demographics
NPI:1285484840
Name:MORLOTE HERNANDEZ, MARYVI
Entity type:Individual
Prefix:
First Name:MARYVI
Middle Name:
Last Name:MORLOTE 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 1:6301 W PARIS ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-5027
Mailing Address - Country:US
Mailing Address - Phone:813-770-0652
Mailing Address - Fax:
Practice Address - Street 1:6301 W PARIS ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-5027
Practice Address - Country:US
Practice Address - Phone:813-770-0652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-332608106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician