Provider Demographics
NPI:1336396662
Name:HERNANDEZ, LEIDA (MS)
Entity Type:Individual
Prefix:
First Name:LEIDA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EDIFICIO MEDICO STA. CRUZ #73
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-6900
Mailing Address - Country:US
Mailing Address - Phone:787-453-9545
Mailing Address - Fax:
Practice Address - Street 1:EDIFICIO MEDICO STA. CRUZ #73
Practice Address - Street 2:SUITE 107
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6900
Practice Address - Country:US
Practice Address - Phone:787-453-9545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR587231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist