Individual
SALAAM IMANI HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CERTIFICATION ECD
Contact information
Practice address
895 BLUE HILL AVE, DORCHESTER, MA 02124
(857) 445-8419
Mailing address
895 BLUE HILL AVE, BOSTON, MA 02124-2902
(857) 445-8419
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000000
NONE
—
Enumeration date
02/11/2019
Last updated
02/11/2019
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