Provider Demographics
NPI:1740279801
Name:HERNANDEZ-LOPEZ, ILIA JUDITH (MD)
Entity type:Individual
Prefix:
First Name:ILIA
Middle Name:JUDITH
Last Name:HERNANDEZ-LOPEZ
Suffix:
Gender:F
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:PO BOX 974
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-0974
Mailing Address - Country:US
Mailing Address - Phone:787-895-4536
Mailing Address - Fax:
Practice Address - Street 1:63 CALLE SAN CARLOS
Practice Address - Street 2:
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678-1775
Practice Address - Country:US
Practice Address - Phone:787-895-4121
Practice Address - Fax:787-895-8059
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10361208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics