Provider Demographics
NPI:1265441307
Name:HERNANDEZ LATORRE, CECILIO (MD)
Entity type:Individual
Prefix:
First Name:CECILIO
Middle Name:
Last Name:HERNANDEZ LATORRE
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:CALLE NISPERO
Mailing Address - Street 2:#78 URB LADERAS DE SAN JUAN
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-9323
Mailing Address - Country:US
Mailing Address - Phone:787-379-1047
Mailing Address - Fax:787-474-8325
Practice Address - Street 1:CALLE NISPERO
Practice Address - Street 2:#78 URB LADERAS DE SAN JUAN
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-9323
Practice Address - Country:US
Practice Address - Phone:787-379-1047
Practice Address - Fax:787-474-8325
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7958208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0081974Medicare ID - Type Unspecified
E73860Medicare UPIN