Provider Demographics
NPI:1417947524
Name:HERNANDEZ JAQUEZ, JOSE A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:HERNANDEZ JAQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637-0428
Mailing Address - Country:US
Mailing Address - Phone:787-873-7511
Mailing Address - Fax:787-873-7511
Practice Address - Street 1:AVENIDA QUILINCHINI #6
Practice Address - Street 2:OFICINA #2 EDIF MILAN
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637
Practice Address - Country:US
Practice Address - Phone:787-873-7511
Practice Address - Fax:787-873-7511
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR4573208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics