Healthcare Provider Details

I. General information

NPI: 1205778040
Provider Name (Legal Business Name): MARIA G HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 AVE HOSTOS
PONCE PR
00716-1115
US

IV. Provider business mailing address

50 CALLE MAR DE CORTES
JUANA DIAZ PR
00795-2108
US

V. Phone/Fax

Practice location:
  • Phone: 787-843-9393
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4850
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: