Healthcare Provider Details

I. General information

NPI: 1255946034
Provider Name (Legal Business Name): LORELIS HERMINA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BO COTTO # 77 URB FELIX CORDOVA DAVILA
MANATI PR
00674-4618
US

IV. Provider business mailing address

HC 3 BOX 12458
CAMUY PR
00627-7339
US

V. Phone/Fax

Practice location:
  • Phone: 787-884-4700
  • Fax: 787-854-0352
Mailing address:
  • Phone: 787-372-5969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number22063
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: