Provider Demographics
NPI:1992278725
Name:HERNANDEZ DIAZ, MARIANE CHARLINE (LM, CPM, CLC)
Entity type:Individual
Prefix:
First Name:MARIANE
Middle Name:CHARLINE
Last Name:HERNANDEZ DIAZ
Suffix:
Gender:F
Credentials:LM, CPM, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9299
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00988-9299
Mailing Address - Country:US
Mailing Address - Phone:787-678-0207
Mailing Address - Fax:
Practice Address - Street 1:J42 CALLE J
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-7135
Practice Address - Country:US
Practice Address - Phone:787-678-0207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99295176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife