Provider Demographics
NPI:1689692675
Name:HERNANDEZ, JOSE A (MD)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:A
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CALLE CANDINA APT 801
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1464
Mailing Address - Country:US
Mailing Address - Phone:787-724-5543
Mailing Address - Fax:
Practice Address - Street 1:150 AVE DE DIEGO STE 604
Practice Address - Street 2:SAN JUAN HEALTH CENTRE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-2318
Practice Address - Country:US
Practice Address - Phone:787-723-2023
Practice Address - Fax:787-723-2021
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6066207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD-26627Medicare UPIN
PR0097519Medicare ID - Type Unspecified