Provider Demographics
NPI:1114404472
Name:HERNANDEZ, MARISOL (HEALTH EDUCATOR MAST)
Entity Type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:HEALTH EDUCATOR MAST
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 876
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-0876
Mailing Address - Country:US
Mailing Address - Phone:787-598-2450
Mailing Address - Fax:
Practice Address - Street 1:CARR 921 KM 2.8
Practice Address - Street 2:BO TEJAS SECTOR ALTURAS DE TEJAS 117
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771
Practice Address - Country:US
Practice Address - Phone:787-598-2450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5069174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5504OtherMCS