Provider Demographics
NPI:1558338145
Name:HERNANDEZ, MIGUEL (MD)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3032
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-3032
Mailing Address - Country:US
Mailing Address - Phone:787-887-2555
Mailing Address - Fax:787-887-2555
Practice Address - Street 1:CALLE GARCIA DE LA NOCEDA B-18
Practice Address - Street 2:VILLAS DE RIO GRANDE
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745-0000
Practice Address - Country:US
Practice Address - Phone:787-887-2555
Practice Address - Fax:787-887-2555
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-02
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2328208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE66454Medicare UPIN
PR21621Medicare ID - Type Unspecified