Provider Demographics
NPI:1932292257
Name:HERNANDEZ - VERA, JOSE MATEO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:MATEO
Last Name:HERNANDEZ - VERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 CALLE REINITA
Mailing Address - Street 2:MIRADERO GARDENS
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-7553
Mailing Address - Country:US
Mailing Address - Phone:939-865-6051
Mailing Address - Fax:
Practice Address - Street 1:RUIZ BELVIS NUM 6
Practice Address - Street 2:
Practice Address - City:MARICAO
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00606
Practice Address - Country:UM
Practice Address - Phone:939-865-6051
Practice Address - Fax:939-865-6052
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16580208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR25050Medicare PIN