Provider Demographics
NPI:1053798181
Name:HERNANDEZ, KRISTINA MARIE (DT)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MARIE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 LAKE ST
Mailing Address - Street 2:APT 2NE
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-2641
Mailing Address - Country:US
Mailing Address - Phone:262-989-6591
Mailing Address - Fax:
Practice Address - Street 1:310 LAKE ST
Practice Address - Street 2:APT 2NE
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-2641
Practice Address - Country:US
Practice Address - Phone:262-989-6591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist