Provider Demographics
NPI:1912127085
Name:HERNANDEZ, OLGA
Entity Type:Individual
Prefix:MRS
First Name:OLGA
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FF16 CALLE 35
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-4606
Mailing Address - Country:US
Mailing Address - Phone:787-778-2807
Mailing Address - Fax:787-778-2807
Practice Address - Street 1:CLINICA INMUNOLOGIA PEDIATRICA
Practice Address - Street 2:AVE. LOMAS VERDES # 100 URB. SANTA JUANITA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-786-6940
Practice Address - Fax:787-786-6940
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR012520163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice