Provider Demographics
NPI:1912923640
Name:HERNANDEZ, MARIA DEL R
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DEL R
Last Name: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 1:175 CALLE MEJICO PH 1
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-2605
Mailing Address - Country:US
Mailing Address - Phone:787-674-1247
Mailing Address - Fax:
Practice Address - Street 1:PB30 CALLE 266
Practice Address - Street 2:3 EXT. COUNTRY CLUB
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982-2767
Practice Address - Country:US
Practice Address - Phone:787-769-7525
Practice Address - Fax:787-769-2428
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1228133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist