Provider Demographics
NPI:1205159027
Name:CORTES HERNANDEZ, JENNIFER A (PSYD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:A
Last Name:CORTES HERNANDEZ
Suffix:
Gender:F
Credentials:PSYD
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 9001
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00908-0001
Mailing Address - Country:US
Mailing Address - Phone:939-644-5336
Mailing Address - Fax:
Practice Address - Street 1:89 TURABO CLUSTERS
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-2545
Practice Address - Country:US
Practice Address - Phone:939-644-5336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3520103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical