Healthcare Provider Details

I. General information

NPI: 1619462363
Provider Name (Legal Business Name): SHEILA M HERNANDEZ SOCIAL WORKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 125 KM 10.1 INT
MOCA PR
00676
US

IV. Provider business mailing address

HC 2 BOX 12465
MOCA PR
00676-8264
US

V. Phone/Fax

Practice location:
  • Phone: 939-267-3563
  • Fax:
Mailing address:
  • Phone: 787-833-0663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number23526
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: