Provider Demographics
NPI:1124869789
Name:HERNANDEZ, MARICARMEN
Entity type:Individual
Prefix:
First Name:MARICARMEN
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB PASEOS DE JACARANDA
Mailing Address - Street 2:FLAMBOYAN 15407
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757-9619
Mailing Address - Country:US
Mailing Address - Phone:787-678-3418
Mailing Address - Fax:
Practice Address - Street 1:URB PASEOS DE JACARANDA
Practice Address - Street 2:FLAMBOYAN 15407
Practice Address - City:SANTA ISABEL
Practice Address - State:PR
Practice Address - Zip Code:00757-9619
Practice Address - Country:US
Practice Address - Phone:787-678-3418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1255156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician