Healthcare Provider Details

I. General information

NPI: 1518421189
Provider Name (Legal Business Name): MARIMAR HERNANDEZ HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 AVE PONCE DE LEON SANTURCE MEDICAL MALL SUITE 308
SAN JUAN PR
00909-1900
US

IV. Provider business mailing address

1717 AVE PONCE DE LEON APT 308
SAN JUAN PR
00909-1932
US

V. Phone/Fax

Practice location:
  • Phone: 787-726-1100
  • Fax:
Mailing address:
  • Phone: 787-726-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number23651
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: