Provider Demographics
NPI:1245335306
Name:HERNANDEZ ORTIZ, CARLOS (DPM)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:HERNANDEZ ORTIZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 AVE RIO HONDO
Mailing Address - Street 2:SUITE #8
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-3114
Mailing Address - Country:US
Mailing Address - Phone:787-784-9352
Mailing Address - Fax:787-784-9352
Practice Address - Street 1:110 AVE RIO HONDO
Practice Address - Street 2:SUITE #8
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-3114
Practice Address - Country:US
Practice Address - Phone:787-784-9352
Practice Address - Fax:787-784-9352
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000066204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRU62114Medicare UPIN
PR48072Medicare ID - Type UnspecifiedPROVIDER ID