Provider Demographics
NPI:1750980561
Name:HERNANDEZ, PAOLA MARISELA
Entity type:Individual
Prefix:MRS
First Name:PAOLA
Middle Name:MARISELA
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 1:6207 RIVER FRUIT CT
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-7325
Mailing Address - Country:US
Mailing Address - Phone:407-881-4751
Mailing Address - Fax:
Practice Address - Street 1:6207 RIVER FRUIT CT
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-7325
Practice Address - Country:US
Practice Address - Phone:407-881-4751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency