Healthcare Provider Details

I. General information

NPI: 1104808799
Provider Name (Legal Business Name): MARIA DEL CARMEN HERNANDEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 11/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE IGNACIO MORALES ACOSTA 72
NARANJITO PR
00719-0372
US

IV. Provider business mailing address

PO BOX 372 CALLE IGNACIO MORALES ACOSTA 72
NARANJITO PR
00719-0372
US

V. Phone/Fax

Practice location:
  • Phone: 787-869-0540
  • Fax: 787-869-0540
Mailing address:
  • Phone: 787-869-0540
  • Fax: 787-869-0540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8352
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberBH0612108
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDM076216
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: