Provider Demographics
NPI:1639986482
Name:HERNANDEZ, DESIRE D
Entity type:Individual
Prefix:
First Name:DESIRE
Middle Name:D
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CHALETS DE ROYAL PALM
Mailing Address - Street 2:EDIF 9 APT 907
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-3027
Mailing Address - Country:US
Mailing Address - Phone:787-677-1481
Mailing Address - Fax:
Practice Address - Street 1:URB PEREZ MORRIS
Practice Address - Street 2:#1 CALLE PONCE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00957
Practice Address - Country:US
Practice Address - Phone:787-677-1481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7959101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7959OtherLICENCIA