Provider Demographics
NPI:1235735960
Name:HERNANDEZ ALEJANDRO, ANA NICOLLE (OD)
Entity Type:Individual
Prefix:MS
First Name:ANA
Middle Name:NICOLLE
Last Name:HERNANDEZ ALEJANDRO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 CALLE LIRIO DE PAZ
Mailing Address - Street 2:LAS FLORES DE MONTEHIEDRA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-436-0089
Mailing Address - Fax:
Practice Address - Street 1:AVE. 65 DE INFANTERIA, KM. 12.3
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-769-2477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000748152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty