Provider Demographics
NPI:1356150783
Name:HERNANDEZ, JOSE GABRIEL SR (PA)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:GABRIEL
Last Name:HERNANDEZ
Suffix:SR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 44 BOX 13436
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-9763
Mailing Address - Country:US
Mailing Address - Phone:939-381-0142
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL MENONITA CIDRA
Practice Address - Street 2:OFICINA 105
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739
Practice Address - Country:US
Practice Address - Phone:787-739-6688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-31
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2448-PA363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical