Healthcare Provider Details

I. General information

NPI: 1801106182
Provider Name (Legal Business Name): MONICA HERNANDEZ-PASTRANA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 03/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE CARITE #130 LAGO ALTO
TRUJILLO ALTO PUERTO RICO
00976
UM

IV. Provider business mailing address

BOSQUE DEL LAGO BC-36 PLAZA9
TRUJILLO ALTO PUERTO RICO
00976
UM

V. Phone/Fax

Practice location:
  • Phone: 787-292-3120
  • Fax:
Mailing address:
  • Phone: 787-402-1712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number18076
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: