Provider Demographics
NPI:1316416696
Name:ILLAS HERNANDEZ, ENRIQUE JOSE I (RN)
Entity Type:Individual
Prefix:MR
First Name:ENRIQUE
Middle Name:JOSE
Last Name:ILLAS HERNANDEZ
Suffix:I
Gender:M
Credentials:RN
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Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:URBANIZACION PUERTO NUEVO CALLE ARAGON
Mailing Address - Street 2:BUZON 605
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00920
Mailing Address - Country:US
Mailing Address - Phone:787-749-2727
Mailing Address - Fax:787-749-2727
Practice Address - Street 1:URBANIZACION PUERTO NUEVO CALLE ARAGON
Practice Address - Street 2:BUZON 605
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920
Practice Address - Country:US
Practice Address - Phone:787-749-2727
Practice Address - Fax:787-749-2727
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR34942A163WG0600X, 171000000X, 172A00000X, 372500000X, 372600000X, 374U00000X, 376G00000X, 163WH0200X
PR34942174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No163WG0600XNursing Service ProvidersRegistered NurseGerontologyGroup - Multi-Specialty
No171000000XOther Service ProvidersMilitary Health Care ProviderGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No172A00000XOther Service ProvidersDriverGroup - Multi-Specialty
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Multi-Specialty