Provider Demographics
NPI:1275053092
Name:PARRA FREITAS, HERNAN
Entity Type:Individual
Prefix:
First Name:HERNAN
Middle Name:
Last Name:PARRA FREITAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 GRAND CONCOURSE DEPT OF
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-7606
Mailing Address - Country:US
Mailing Address - Phone:718-239-8375
Mailing Address - Fax:718-340-3074
Practice Address - Street 1:1650 GRAND CONCOURSE
Practice Address - Street 2:DEPT OF OB/GYN 5TH FL
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457
Practice Address - Country:US
Practice Address - Phone:718-239-8375
Practice Address - Fax:718-340-3074
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY315877207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program