Provider Demographics
NPI:1700481405
Name:GERENA HERNANDEZ, OLGA ALICIA (PA)
Entity Type:Individual
Prefix:DR
First Name:OLGA
Middle Name:ALICIA
Last Name:GERENA HERNANDEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:CALLE 3 #F30
Mailing Address - Street 2:VILLAS DE LOIZA
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-4212
Mailing Address - Country:US
Mailing Address - Phone:787-408-6818
Mailing Address - Fax:
Practice Address - Street 1:CARR. #906 KM. 11.5 COCONUT GROVE PLAZA
Practice Address - Street 2:LOCAL 4
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-850-4515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR785363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant