Provider Demographics
NPI:1790907095
Name:HERNANDEZ-STE, REBECA C
Entity Type:Individual
Prefix:MRS
First Name:REBECA
Middle Name:C
Last Name:HERNANDEZ-STE
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 1:1034 AVE HOSTOS
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-1115
Mailing Address - Country:US
Mailing Address - Phone:787-843-9393
Mailing Address - Fax:
Practice Address - Street 1:1034 AVE HOSTOS
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-1115
Practice Address - Country:US
Practice Address - Phone:787-843-9393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2484174400000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No174400000XOther Service ProvidersSpecialist