Provider Demographics
NPI:1932100088
Name:HERNANDEZ, RENE A (MD)
Entity Type:Individual
Prefix:DR
First Name:RENE
Middle Name:A
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RENE
Other - Middle Name:
Other - Last Name:HERNANDEZ HERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1845 CARR 2
Mailing Address - Street 2:SUITE 809
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-7206
Mailing Address - Country:US
Mailing Address - Phone:787-798-1070
Mailing Address - Fax:787-798-1004
Practice Address - Street 1:1845 CARR 2
Practice Address - Street 2:SUITE 809
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-7206
Practice Address - Country:US
Practice Address - Phone:787-798-1070
Practice Address - Fax:787-798-1004
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4764207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC-79508Medicare UPIN