Provider Demographics
NPI:1851392856
Name:HERNANDEZ, JUANA EVANGELISTA (MD)
Entity Type:Individual
Prefix:MS
First Name:JUANA
Middle Name:EVANGELISTA
Last Name: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 1:5616 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3419
Mailing Address - Country:US
Mailing Address - Phone:718-439-5440
Mailing Address - Fax:718-492-2776
Practice Address - Street 1:5616 6TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220
Practice Address - Country:US
Practice Address - Phone:718-439-5440
Practice Address - Fax:718-567-9772
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237919-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02792996Medicaid
L16715Medicare UPIN
NYA400038946Medicare PIN