Provider Demographics
NPI:1285003319
Name:HERNANDEZ, EFRAIN
Entity Type:Individual
Prefix:DR
First Name:EFRAIN
Middle Name:
Last Name:HERNANDEZ
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 1:13 CALLE BRILLANTE
Mailing Address - Street 2:URB. MARTELLARE
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-4254
Mailing Address - Country:US
Mailing Address - Phone:787-297-5854
Mailing Address - Fax:
Practice Address - Street 1:13 CALLE BRILLANTE
Practice Address - Street 2:URB. MARTELLARE
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4254
Practice Address - Country:US
Practice Address - Phone:787-297-5854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16186208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice