Healthcare Provider Details

I. General information

NPI: 1992278725
Provider Name (Legal Business Name): MARIANE CHARLINE HERNANDEZ DIAZ LM, CPM, CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2019
Last Update Date: 01/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

J42 CALLE J
CAROLINA PR
00987-7135
US

IV. Provider business mailing address

PO BOX 9299
CAROLINA PR
00988-9299
US

V. Phone/Fax

Practice location:
  • Phone: 787-678-0207
  • Fax:
Mailing address:
  • Phone: 787-678-0207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number99295
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: