Provider Demographics
NPI:1811962178
Name:HERNANDEZ GONZALEZ, JOHNNY
Entity type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:
Last Name:HERNANDEZ GONZALEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:B11 EASTSIDE CT
Mailing Address - Street 2:BALDWIN PARK
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4117
Mailing Address - Country:US
Mailing Address - Phone:787-798-7070
Mailing Address - Fax:787-787-2107
Practice Address - Street 1:CARIMED PLZ
Practice Address - Street 2:B-1 CALLE SANTA CRUZ SUITE 403
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6928
Practice Address - Country:US
Practice Address - Phone:787-798-7070
Practice Address - Fax:787-787-2107
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9578207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6210026OtherHUMANA
PR81746OtherTRIPLE S
PR067660OtherCRUZ AZUL
PRE33823Medicare UPIN
PR067660OtherCRUZ AZUL