Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 307 | PR |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 307 | PR |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | 307 | PR |
N | 152WP0200X | Pediatric Optomitrist | 307 | PR |
N | 152WS0006X | Sports Vision | 307 | PR |
N | 152WV0400X | Optomitrist - Vision Therapist | 307 | PR |
N | 152WX0102X | Occupational Vision | 307 | PR |
N | 156FC0800X | Contact Lens | 307 | PR |
N | 156FC0801X | Contact Lens Fitter | 307 | PR |
N | 156FX1100X | Ophthalmic | 307 | PR |
N | 156FX1202X | Optometric Technician | 307 | PR |
N | 156FX1800X | Optician | 307 | PR |
N | 156FX1900X | Orthoptist | 307 | PR |
NPI | 1548373681 |
---|---|
Provider Name | Ms. Maria De La Altagracia Hernandez |
First Address | Caguas, PR 00725-2265 |
Second Address | Caguas, PR 00725-2265 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2006 |
Last Update Date | 14/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
215961 | PREFERRED (01) | PR |
55394HE | TSSS (01) | PR |
7250096 | HUMANA HEALTH PLAN (01) | PR |