Provider Demographics
NPI:1407206535
Name:HERNANDEZ, ELISA
Entity Type:Individual
Prefix:MRS
First Name:ELISA
Middle Name:
Last Name: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:CARRETERA 172 URB. TURABO GARDENS
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-6660
Mailing Address - Country:US
Mailing Address - Phone:787-469-1626
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 172
Practice Address - Street 2:URB. TURABO GARDENS
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00726-6660
Practice Address - Country:US
Practice Address - Phone:787-469-1626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1669133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist