Provider Demographics
NPI:1043499445
Name:HERNANDEZ, JOHANNY
Entity Type:Individual
Prefix:DR
First Name:JOHANNY
Middle Name:
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:COND JARDINES DE MONTEHIEDRA
Mailing Address - Street 2:AVE. LOS ROMEROS 1500 APT. 1007
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-7011
Mailing Address - Country:US
Mailing Address - Phone:787-734-0459
Mailing Address - Fax:
Practice Address - Street 1:140 AVE LAS CUMBRES
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5523
Practice Address - Country:US
Practice Address - Phone:787-720-5050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16879261QH0100X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service