Provider Demographics
NPI:1669716460
Name:FELIX-HERNANDEZ, GLADYS
Entity type:Individual
Prefix:
First Name:GLADYS
Middle Name:
Last Name:FELIX-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:PO BOX 1350
Mailing Address - Street 2:
Mailing Address - City:SAINT JUST
Mailing Address - State:PR
Mailing Address - Zip Code:00978-1350
Mailing Address - Country:US
Mailing Address - Phone:787-292-7979
Mailing Address - Fax:787-292-7999
Practice Address - Street 1:CKD CLINICS OF CAROLINA
Practice Address - Street 2:
Practice Address - City:SAINT JUST STATION
Practice Address - State:PR
Practice Address - Zip Code:00976-2501
Practice Address - Country:US
Practice Address - Phone:787-710-2532
Practice Address - Fax:787-292-7999
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR24251163WH0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0500XNursing Service ProvidersRegistered NurseHemodialysis
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR24251OtherLIC