Provider Demographics
NPI:1952579286
Name:HERNANDEZ, CARLOS
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:
Last Name:HERNANDEZ
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:PO BOX 176
Mailing Address - Street 2:
Mailing Address - City:OROCOVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00720-0176
Mailing Address - Country:US
Mailing Address - Phone:787-867-3010
Mailing Address - Fax:787-867-3371
Practice Address - Street 1:42 SALIDA COAMO
Practice Address - Street 2:CARR 155 KM 27.4
Practice Address - City:OROCOVIS
Practice Address - State:PR
Practice Address - Zip Code:00720-4444
Practice Address - Country:US
Practice Address - Phone:787-867-3010
Practice Address - Fax:787-867-3371
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11370053416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0059271Medicare PIN