Provider Demographics
NPI:1710439724
Name:HERNANDEZ, GLORIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 CALLE BRITTON
Mailing Address - Street 2:URB MONTE ALTO
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-4080
Mailing Address - Country:US
Mailing Address - Phone:787-326-2259
Mailing Address - Fax:939-204-9060
Practice Address - Street 1:C9 AVE LUIS MUNOZ MARIN
Practice Address - Street 2:URB CAGUAX
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-3330
Practice Address - Country:US
Practice Address - Phone:787-326-2259
Practice Address - Fax:939-204-9060
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001509103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR001509OtherLICENCIA