Provider Demographics
NPI:1841653722
Name:HERNANDEZ HERNANDEZ, MARTA
Entity type:Individual
Prefix:
First Name:MARTA
Middle Name:
Last Name:HERNANDEZ HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 CALLE VISTA DEL MAR
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-9733
Mailing Address - Country:US
Mailing Address - Phone:787-208-0575
Mailing Address - Fax:
Practice Address - Street 1:466 CALLE VISTA DEL MAR
Practice Address - Street 2:
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678-9733
Practice Address - Country:US
Practice Address - Phone:787-208-0575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5980183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5980OtherPHARMACY TECHNICIAN