Provider Demographics
NPI:1760512511
Name:RODON HERNANDEZ, DIANA EVELYN (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:EVELYN
Last Name:RODON HERNANDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2053 AVE PEDRO ALBIZU CAMPOS
Mailing Address - Street 2:PMB 329
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-5950
Mailing Address - Country:US
Mailing Address - Phone:787-890-0751
Mailing Address - Fax:
Practice Address - Street 1:2053 AVE PEDRO ALBIZU CAMPOS
Practice Address - Street 2:PMB 329
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-5950
Practice Address - Country:US
Practice Address - Phone:787-890-0751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14394208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR21415ROOtherSSS
002-1415Medicare ID - Type Unspecified
PRI-04234Medicare UPIN