Provider Demographics
NPI:1114325503
Name:CHEVERE HERNANDEZ, LISSETTE
Entity Type:Individual
Prefix:
First Name:LISSETTE
Middle Name:
Last Name:CHEVERE 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:HC 01 BOX 5516
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00659
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HC 01 BOX 5516
Practice Address - Street 2:
Practice Address - City:HATILLO
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00659
Practice Address - Country:UM
Practice Address - Phone:787-983-0153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6502471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography