Healthcare Provider Details

I. General information

NPI: 1770785909
Provider Name (Legal Business Name): DOELYS HERNANDEZ LND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

359 CALLE SAN CLAUDIO S SUITE 205 CUPEY PROFESSIONAL MALL
SAN JUAN PR
00926-9907
US

IV. Provider business mailing address

HC 4 BOX 5373
GUAYNABO PR
00971-9516
US

V. Phone/Fax

Practice location:
  • Phone: 787-308-1100
  • Fax:
Mailing address:
  • Phone: 787-758-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number1352
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: