Provider Demographics
NPI:1982697751
Name:HERNANDEZ LIYIM, LUISA (MD)
Entity Type:Individual
Prefix:DR
First Name:LUISA
Middle Name:
Last Name:HERNANDEZ LIYIM
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:PO BOX 1311
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-1311
Mailing Address - Country:US
Mailing Address - Phone:787-889-2267
Mailing Address - Fax:787-889-2267
Practice Address - Street 1:G5 CALLE PRINCIPAL
Practice Address - Street 2:URBANIZACION BARALT
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-3774
Practice Address - Country:US
Practice Address - Phone:787-889-2267
Practice Address - Fax:787-889-2267
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10151207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0088402Medicare ID - Type Unspecified
PRG41106Medicare UPIN