Provider Demographics
NPI:1477399533
Name:HERNANDEZ, MARI CARMEN (1566 PA)
Entity type:Individual
Prefix:
First Name:MARI
Middle Name:CARMEN
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:1566 PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7023 AVE AGUSTIN RAMOS CALERO # 1
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-3445
Mailing Address - Country:US
Mailing Address - Phone:787-918-0510
Mailing Address - Fax:
Practice Address - Street 1:7023 AVE AGUSTIN RAMOS CALERO # 1
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-3445
Practice Address - Country:US
Practice Address - Phone:787-918-0510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1566363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant