Provider Demographics
NPI:1891983599
Name:HERNANDEZ, ANGELA T (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:T
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:PO BOX 194199
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-4199
Mailing Address - Country:US
Mailing Address - Phone:787-272-2079
Mailing Address - Fax:
Practice Address - Street 1:FOUNTAINBLEU VLG
Practice Address - Street 2:203
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-4732
Practice Address - Country:US
Practice Address - Phone:787-272-2079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR#4049208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics