Provider Demographics
NPI:1851568794
Name:HERNANDEZ, VANESSA (MEDICAL TECHNOLOGY)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MEDICAL TECHNOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 47
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-0047
Mailing Address - Country:US
Mailing Address - Phone:787-818-1325
Mailing Address - Fax:
Practice Address - Street 1:CARR 420 KM 0.4
Practice Address - Street 2:BO VOLADORAS
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676
Practice Address - Country:US
Practice Address - Phone:787-818-1325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-09
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1013246QL0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QL0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR31410OtherTRIPLE SSS
PR660706058OtherINTERNATIONAL MEDICAL CARD
PR660706058OtherMEDICAL CARD SYSTEM
PR660706058OtherBELLA VISTA
PR31410Medicaid