Provider Demographics
NPI:1477515310
Name:HERNANDEZ VIERA, EDGAR CARLOS (MD)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:CARLOS
Last Name:HERNANDEZ VIERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:369 CALLE DE DIEGO SUITE 607
Mailing Address - Street 2:TORRE MEDICA SAN FRANCISCO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00923-3003
Mailing Address - Country:US
Mailing Address - Phone:787-764-9560
Mailing Address - Fax:787-771-6161
Practice Address - Street 1:369 CALLE DE DIEGO
Practice Address - Street 2:SUITE 607
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-3003
Practice Address - Country:US
Practice Address - Phone:787-764-9560
Practice Address - Fax:787-771-6161
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR132072084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0090120Medicare ID - Type Unspecified
G97127Medicare UPIN