Provider Demographics
NPI:1578338927
Name:HERNANDEZ, JORGE ERNESTO (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:ERNESTO
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 CALLE SGTO LUIS MEDINA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-3817
Mailing Address - Country:US
Mailing Address - Phone:915-312-8300
Mailing Address - Fax:
Practice Address - Street 1:361 CALLE SGTO LUIS MEDINA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3817
Practice Address - Country:US
Practice Address - Phone:915-312-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1612363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical