Healthcare Provider Details

I. General information

NPI: 1639465461
Provider Name (Legal Business Name): MARIELLA HILLEBRAND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE MANUEL F. ROSSY ESQ. ISABEL II
BAYAMON PR
00960
US

IV. Provider business mailing address

PO BOX 262
BAYAMON PR
00960-0262
US

V. Phone/Fax

Practice location:
  • Phone: 787-995-1900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberR4398
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2081P0301X
TaxonomyBrain Injury Medicine (Physical Medicine & Rehabilitation) Physician
License Number18217
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number18217
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number18217
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: