Individual
DIANA HERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
614 80TH ST, APT. 1R, BROOKLYN, NY 11209-4021
(917) 806-2458
Mailing address
614 80TH ST, APT. 1R, BROOKLYN, NY 11209-4021
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
1221874
NY
Other
Enumeration date
10/26/2012
Last updated
10/26/2012
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