Provider Demographics
NPI:1912455007
Name:HERNANDEZ ZAMORA, NOEMI (MA44510)
Entity type:Individual
Prefix:
First Name:NOEMI
Middle Name:
Last Name:HERNANDEZ ZAMORA
Suffix:
Gender:F
Credentials:MA44510
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7425 SW 31ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-2761
Mailing Address - Country:US
Mailing Address - Phone:786-317-4696
Mailing Address - Fax:
Practice Address - Street 1:7425 SW 31ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-2761
Practice Address - Country:US
Practice Address - Phone:786-317-4696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-16
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA44510171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor