Provider Demographics
NPI:1366717449
Name:HERNANDEZ, MARIA SALVADORA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:SALVADORA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 HUGHES AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-7539
Mailing Address - Country:US
Mailing Address - Phone:907-452-1648
Mailing Address - Fax:907-456-4849
Practice Address - Street 1:605 HUGHES AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-7539
Practice Address - Country:US
Practice Address - Phone:907-452-1648
Practice Address - Fax:907-459-4849
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMH3237Medicaid