Provider Demographics
NPI:1821541830
Name:HERNANDEZ CRESPO, KENDRICK RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:KENDRICK
Middle Name:RAY
Last Name:HERNANDEZ CRESPO
Suffix:
Gender:M
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:HC 4 BOX 19560
Mailing Address - Street 2:
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-7637
Mailing Address - Country:US
Mailing Address - Phone:787-242-3166
Mailing Address - Fax:
Practice Address - Street 1:HC 4 BOX 19560
Practice Address - Street 2:
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627-7637
Practice Address - Country:US
Practice Address - Phone:787-242-3166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-26
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PR023013208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program