Healthcare Provider Details

I. General information

NPI: 1063300416
Provider Name (Legal Business Name): JAMALIE HERNANDEZ DE LA CRUZ PS.L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 110 KM 8.0 INT BO MARIAS
MOCA PR
00676-0000
US

IV. Provider business mailing address

HC 1 BOX 6856
MOCA PR
00676-9018
US

V. Phone/Fax

Practice location:
  • Phone: 939-903-7167
  • Fax:
Mailing address:
  • Phone: 786-945-4457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number7958
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: