Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 10422 | PR |
NPI | 1013985662 |
---|---|
Provider Name | Ms. Maria Isabel Hernandez |
First Address | Ciales, PR 00638-3218 |
Second Address | Ciales, PR 00638-3218 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2006 |
Last Update Date | 05/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G37260 | (02) | PR |