Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 0321 | MP |
N | 2080P0214X | Pediatric Pulmonologist | 0321 | MP |
NPI | 1174658124 |
---|---|
Provider Name | Mary Elizabeth Coronel Hernandez |
First Address | Tamuning, GU 96913-4112 |
Second Address | Saipan, MP 96950 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 09/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
92873529 | COLORADO MEDICAID PROGRAM (01) | CO |