Provider Demographics
NPI:1821285297
Name:HERNANDEZ, JOSE RAFAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:RAFAEL
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:I2 CALLE 8
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-2088
Mailing Address - Country:US
Mailing Address - Phone:787-743-1703
Mailing Address - Fax:
Practice Address - Street 1:8 ST I-2
Practice Address - Street 2:EXT SAN ANTONIO
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-2088
Practice Address - Country:US
Practice Address - Phone:787-743-1703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-01
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR00078103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist