Provider Demographics
NPI:1619394640
Name:HERNANDEZ GONZALEZ ORTHOPEDIC SERVICES, PSC
Entity Type:Organization
Organization Name:HERNANDEZ GONZALEZ ORTHOPEDIC SERVICES, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-798-7050
Mailing Address - Street 1:B11 EASTSIDE CT
Mailing Address - Street 2:BALDWIN PARK
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4117
Mailing Address - Country:US
Mailing Address - Phone:787-798-7050
Mailing Address - Fax:787-787-2107
Practice Address - Street 1:B1 CALLE SANTA CRUZ SUITE 403
Practice Address - Street 2:CARIMED PLAZA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6928
Practice Address - Country:US
Practice Address - Phone:787-798-7050
Practice Address - Fax:787-787-2107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9578207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic TraumaGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR9057OtherAMERICAN HEALTH