Healthcare Provider Details

I. General information

NPI: 1174658124
Provider Name (Legal Business Name): MARY ELIZABETH CORONEL HERNANDEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500409 CHALAN KANOA COMMONWEALTH HEALTH CENTER
SAIPAN MP
96950
US

IV. Provider business mailing address

535 N MARINE CORPS DR STE 1A
TAMUNING GU
96913-4112
US

V. Phone/Fax

Practice location:
  • Phone: 670-234-8950
  • Fax: 670-234-8700
Mailing address:
  • Phone: 671-647-6669
  • Fax: 671-647-6277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number0321
License Number StateMP
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0321
License Number StateMP

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: