Provider Demographics
NPI:1649009648
Name:HERNANDEZ ORTIZ, MARIAN (MD)
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:
Last Name:HERNANDEZ ORTIZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. RIO PIEDRAS HEIGHTS 1684 CALLE SUNGARI
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-221-3381
Mailing Address - Fax:
Practice Address - Street 1:PLAZA BAIROA CARR #1 VILLA BLANCA INDUSTRIAL PARK
Practice Address - Street 2:SUITE 120
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727
Practice Address - Country:US
Practice Address - Phone:787-920-4090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical