Provider Demographics
NPI:1093025884
Name:BADILLO HERNANDEZ, JOSE ARIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ARIEL
Last Name:BADILLO HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1198
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-1198
Mailing Address - Country:US
Mailing Address - Phone:787-658-7098
Mailing Address - Fax:787-658-6108
Practice Address - Street 1:CARR # 2 KM 124.7
Practice Address - Street 2:EDIFICIO PUNTO ORO SUITE 9
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-658-7098
Practice Address - Fax:787-658-6108
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR18051208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRED303AMedicare Oscar/Certification