Provider Demographics
NPI:1376318790
Name:HERNANDEZ DURAN, JESUS EDUARDO (PA)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:EDUARDO
Last Name:HERNANDEZ DURAN
Suffix:
Gender:M
Credentials:PA
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 50238
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-0238
Mailing Address - Country:US
Mailing Address - Phone:939-227-5004
Mailing Address - Fax:
Practice Address - Street 1:2118 PASEO ALFA
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-4235
Practice Address - Country:US
Practice Address - Phone:939-227-5004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001939-P.A.363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant