Provider Demographics
NPI:1790208098
Name:HERNANDEZ, YANILDA IVETTE SR
Entity Type:Individual
Prefix:
First Name:YANILDA
Middle Name:IVETTE
Last Name:HERNANDEZ
Suffix:SR
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:HC 01 BOX 7121
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00778
Mailing Address - Country:AX
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BARRIO HATO NUEVO SOLAR 173
Practice Address - Street 2:
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-675-4424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR74872163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR5058067OtherMOLINA