Provider Demographics
NPI:1619661519
Name:HERNANDEZ CABRERA, AMALIS YUDITH
Entity Type:Individual
Prefix:
First Name:AMALIS
Middle Name:YUDITH
Last Name:HERNANDEZ CABRERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 CALLE DEL RIO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00912-4230
Mailing Address - Country:US
Mailing Address - Phone:787-615-5243
Mailing Address - Fax:
Practice Address - Street 1:CALLE 1, LOTE B-1, URB. VILLAS DE LOIZA
Practice Address - Street 2:300 CALLE 1, CANOVANAS, LOIZA
Practice Address - City:LOIZA
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:787-876-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8062183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist