Provider Demographics
NPI:1912921628
Name:HERNANDEZ-ORTIZ, TOMAS (MD; MPH)
Entity Type:Individual
Prefix:DR
First Name:TOMAS
Middle Name:
Last Name:HERNANDEZ-ORTIZ
Suffix:
Gender:M
Credentials:MD; MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 CALLE SANTA CRUZ
Mailing Address - Street 2:SUITE 308
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-6910
Mailing Address - Country:US
Mailing Address - Phone:787-786-4125
Mailing Address - Fax:
Practice Address - Street 1:73 CALLE SANTA CRUZ
Practice Address - Street 2:SUITE 308
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6910
Practice Address - Country:US
Practice Address - Phone:787-786-4125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR37072084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD-33462Medicare UPIN