Provider Demographics
NPI:1376538785
Name:HERNANDEZ, RAHADAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:RAHADAMES
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1747 CALLE ALABAMA
Mailing Address - Street 2:SAN GERARDO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-3451
Mailing Address - Country:US
Mailing Address - Phone:787-767-0212
Mailing Address - Fax:
Practice Address - Street 1:371 AVE DE DIEGO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-1711
Practice Address - Country:US
Practice Address - Phone:787-782-9999
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10571208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF94452Medicare UPIN
PR83028Medicare ID - Type Unspecified