Healthcare Provider Details

I. General information

NPI: 1982697751
Provider Name (Legal Business Name): LUISA HERNANDEZ LIYIM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

G5 CALLE PRINCIPAL URBANIZACION BARALT
FAJARDO PR
00738-3774
US

IV. Provider business mailing address

PO BOX 1311
FAJARDO PR
00738-1311
US

V. Phone/Fax

Practice location:
  • Phone: 787-889-2267
  • Fax: 787-889-2267
Mailing address:
  • Phone: 787-435-4323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number10151
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: