Provider Demographics
NPI:1376700369
Name:GRACIA, HECTOR
Entity Type:Individual
Prefix:MR
First Name:HECTOR
Middle Name:
Last Name:GRACIA
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 1:59 CALLE FLAMBOYAN
Mailing Address - Street 2:
Mailing Address - City:HORMIGUEROS
Mailing Address - State:PR
Mailing Address - Zip Code:00660-8619
Mailing Address - Country:US
Mailing Address - Phone:787-605-8192
Mailing Address - Fax:787-833-7927
Practice Address - Street 1:183 MENDEZ VIGO W
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-3228
Practice Address - Country:US
Practice Address - Phone:787-605-8192
Practice Address - Fax:787-833-7927
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTCAMB863416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRW97418Medicare UPIN