Provider Demographics
NPI:1841481884
Name:HERNANDEZ, JOSE (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 CALLE DE DIEGO
Mailing Address - Street 2:TORRE SAN FRANCISCO SUITE 609
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00923-3003
Mailing Address - Country:US
Mailing Address - Phone:787-751-1733
Mailing Address - Fax:787-282-8709
Practice Address - Street 1:369 CALLE DE DIEGO
Practice Address - Street 2:TORRE SAN FRANCISCO SUITE 609
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-3003
Practice Address - Country:US
Practice Address - Phone:787-751-1733
Practice Address - Fax:787-282-8709
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4048174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR25146OtherTRIPLE S
PR25146OtherTRIPLE S