Provider Demographics
NPI:1770530230
Name:HERNANDEZ, ELISEO (DM D)
Entity type:Individual
Prefix:DR
First Name:ELISEO
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:DM D
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 257
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-0257
Mailing Address - Country:US
Mailing Address - Phone:787-854-5633
Mailing Address - Fax:787-854-5633
Practice Address - Street 1:CARRETERA #2 KM 47.8
Practice Address - Street 2:DOCTOR CENTER HOSPITAL TORRE MEDICAL SUITE # 401
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-0257
Practice Address - Country:US
Practice Address - Phone:787-854-5633
Practice Address - Fax:787-854-5633
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice