Provider Demographics
NPI:1134522659
Name:HERNANDEZ, YISELYS
Entity type:Individual
Prefix:
First Name:YISELYS
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:#3197 STREET GUAYABO
Mailing Address - Street 2:PRADERAS DEL RIO
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-9120
Mailing Address - Country:US
Mailing Address - Phone:787-995-0884
Mailing Address - Fax:
Practice Address - Street 1:STREET # 831 KM. 4.7
Practice Address - Street 2:BO MINILLAS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-995-0884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator