Provider Demographics
NPI:1881026201
Name:HERNANDEZ, WILLIAM III
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:HERNANDEZ
Suffix:III
Gender:M
Credentials:
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 827
Mailing Address - Street 2:
Mailing Address - City:BARCELONETA
Mailing Address - State:PR
Mailing Address - Zip Code:00617-0827
Mailing Address - Country:US
Mailing Address - Phone:787-502-4413
Mailing Address - Fax:
Practice Address - Street 1:CALLE 1 BLOQUE 2 751
Practice Address - Street 2:URB PASEO REAL
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-0000
Practice Address - Country:US
Practice Address - Phone:787-502-4413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR660807512335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
660807512OtherINDIVIDUAL TAX ID
0000000000Medicare NSC