Healthcare Provider Details

I. General information

NPI: 1396466413
Provider Name (Legal Business Name): PABLO E HERNANDEZ MARRERO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. UNIVERSIDAD INTERAMERICANA SAN GERMAN 122-B
SAN GERMAN PR
00683
US

IV. Provider business mailing address

URB ALTURAS DE MAYAGUEZ 402 ALMIRANTE
MAYAGUEZ PR
00682
US

V. Phone/Fax

Practice location:
  • Phone: 787-366-2422
  • Fax:
Mailing address:
  • Phone: 787-458-9987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number022977
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: