Provider Demographics
NPI:1669224614
Name:HERNANDEZ, JORGE IVAN (DR)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:IVAN
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB LA MESETA CALLE LOS GONZALEZ #331
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-203-2029
Mailing Address - Fax:
Practice Address - Street 1:509 AVE ANDALUCIA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-4132
Practice Address - Country:US
Practice Address - Phone:787-221-9282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR972111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor