Individual
LATICIA HERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3139 ELECTRIC AVE APT 3, PORT HURON, MI 48060-8103
(810) 990-9312
Mailing address
3139 ELECTRIC AVE APT 3, PORT HURON, MI 48060-8103
(810) 990-9312
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
H 655 488 785 108
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
86663636
—
MI
Enumeration date
10/15/2015
Last updated
10/15/2015
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