Provider Demographics
NPI:1558784405
Name:HERNANDEZ, PRIMITIVO
Entity Type:Individual
Prefix:
First Name:PRIMITIVO
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4180 HUTCHINSON RIVER PKWY E APT 21F
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-4863
Mailing Address - Country:US
Mailing Address - Phone:917-224-3556
Mailing Address - Fax:
Practice Address - Street 1:4180 HUTCHINSON RIVER PKWY E APT 21F
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-4863
Practice Address - Country:US
Practice Address - Phone:917-224-3556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator