Provider Demographics
NPI:1437188760
Name:HERNANDEZ, LIZANETTE (AUD)
Entity Type:Individual
Prefix:
First Name:LIZANETTE
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CARR. 174 BLOQUE 21-27
Mailing Address - Street 2:URB. SANTA ROSA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-740-4444
Mailing Address - Fax:787-740-4440
Practice Address - Street 1:CARR. 174 BLOQUE 21-27
Practice Address - Street 2:URB. SANTA ROSA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-740-4444
Practice Address - Fax:787-740-4444
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR560231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0064304Medicare ID - Type Unspecified