Healthcare Provider Details

I. General information

NPI: 1013265958
Provider Name (Legal Business Name): LLANILYS JUSTIZ HERNANDEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2012
Last Update Date: 01/30/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 501 BO MARUENO KM 1.9
PONCE PR
00731
US

IV. Provider business mailing address

HC 8 BOX 8203
PONCE PR
00731
US

V. Phone/Fax

Practice location:
  • Phone: 786-333-6755
  • Fax:
Mailing address:
  • Phone: 786-333-6755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18730
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: