Provider Demographics
NPI:1275616716
Name:HERNANDEZ, SIXTA (PHTECH)
Entity Type:Individual
Prefix:
First Name:SIXTA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PHTECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 CALLE 9
Mailing Address - Street 2:BARRIADA ISRAEL
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-1637
Mailing Address - Country:US
Mailing Address - Phone:787-647-6749
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 845 KM3.0
Practice Address - Street 2:CENTRO COMERCIAL FAIR VIEW
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-760-0024
Practice Address - Fax:787-283-0140
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3801183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician