Healthcare Provider Details

I. General information

NPI: 1891604377
Provider Name (Legal Business Name): STEPHANIE MARIE HERNANDEZ JIMENEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB HACIENDA LA SABANA 85 CALLE CARACOL
CAMUY PR
00627-0000
US

IV. Provider business mailing address

HC 6 BOX 65203
CAMUY PR
00627-8849
US

V. Phone/Fax

Practice location:
  • Phone: 787-527-0735
  • Fax:
Mailing address:
  • Phone: 787-527-0735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number8168
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: