Provider Demographics
NPI:1649269820
Name:HERNANDEZ DE LA FUENTE, MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:HERNANDEZ DE LA FUENTE
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:CENTRO INTERNACIONAL DE MERCADEO 100 CARR. 165
Mailing Address - Street 2:STE. 303
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968
Mailing Address - Country:US
Mailing Address - Phone:787-277-0847
Mailing Address - Fax:787-277-0942
Practice Address - Street 1:CENTRO INTERNACIONAL DE MERCADEO 100 CARR. 165
Practice Address - Street 2:STE. 303
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968
Practice Address - Country:US
Practice Address - Phone:787-277-0847
Practice Address - Fax:787-277-0942
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14361208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH69543Medicare UPIN
PR84673Medicare ID - Type UnspecifiedPHYSIATRIST