Provider Demographics
NPI:1578803482
Name:HERNANDEZ, RICHARD (MS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7130 AVE AGUSTIN RAMOS CALERO
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662
Mailing Address - Country:US
Mailing Address - Phone:929-245-5258
Mailing Address - Fax:
Practice Address - Street 1:7130 AVE: AGUSTIN RAMOS CALERO
Practice Address - Street 2:MUNDI CLINICS DE ISABELA
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-3615
Practice Address - Country:US
Practice Address - Phone:929-245-5258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-01
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004588103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily