Healthcare Provider Details

I. General information

NPI: 1780142562
Provider Name (Legal Business Name): ISABEL M. HERNANDEZ-IBARRA PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2019
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 AVE CUPEY GARDENS LOTE 3 CUPEY GARDENS PLAZA
SAN JUAN PR
00926
US

IV. Provider business mailing address

15089 CALLE SENDERO CORTO URB LAS HACIENDAS
CANOVANAS PR
00729
US

V. Phone/Fax

Practice location:
  • Phone: 787-292-0205
  • Fax:
Mailing address:
  • Phone: 787-967-3237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6221
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: