Provider Demographics
NPI:1174658124
Name:HERNANDEZ, MARY ELIZABETH CORONEL (MD)
Entity Type:Individual
Prefix:
First Name:MARY ELIZABETH
Middle Name:CORONEL
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:535 N MARINE CORPS DR
Mailing Address - Street 2:STE 1A
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-4112
Mailing Address - Country:US
Mailing Address - Phone:671-647-6669
Mailing Address - Fax:671-647-6277
Practice Address - Street 1:500409 CHALAN KANOA
Practice Address - Street 2:COMMONWEALTH HEALTH CENTER
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950
Practice Address - Country:US
Practice Address - Phone:670-234-8950
Practice Address - Fax:670-234-8700
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2020-12-09
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Provider Licenses
StateLicense IDTaxonomies
MP03212080P0214X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO92873529OtherCOLORADO MEDICAID PROGRAM