Provider Demographics
NPI:1225080880
Name:HERNANDEZ LEBRON, GIOVAN E (MD)
Entity Type:Individual
Prefix:
First Name:GIOVAN
Middle Name:E
Last Name:HERNANDEZ LEBRON
Suffix:
Gender:M
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:URB CUIDAD JARDIN 51 CALLE SIEMPREVIVA
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-0000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:GRUPO MEDICO SAMARITANO
Practice Address - Street 2:BARRIO BARRAZAS CARR 182 KM 3
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00981-0000
Practice Address - Country:US
Practice Address - Phone:787-661-1070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13955208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
H99104Medicare UPIN