Provider Demographics
NPI:1972091445
Name:HERNANDEZ, FELIZ MARIE DIMAANO (SPT)
Entity type:Individual
Prefix:MS
First Name:FELIZ MARIE
Middle Name:DIMAANO
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:SPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 FRONT AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093
Mailing Address - Country:US
Mailing Address - Phone:410-823-4263
Mailing Address - Fax:
Practice Address - Street 1:9501 OLD ANNAPOLIS RD STE 125
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-6355
Practice Address - Country:US
Practice Address - Phone:410-997-1063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program