Provider Demographics
NPI:1316562382
Name:HERNANDEZ-HERNANDEZ, CRISTAL IMAR
Entity Type:Individual
Prefix:
First Name:CRISTAL
Middle Name:IMAR
Last Name:HERNANDEZ-HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 611
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-0611
Mailing Address - Country:US
Mailing Address - Phone:787-329-2499
Mailing Address - Fax:
Practice Address - Street 1:CARR 421 KM 0.1 BO CAPA INT
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-329-2499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program