Provider Demographics
NPI:1902930175
Name:HERNANDEZ, JOSE A (BOCOP C PED RPT)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:BOCOP C PED RPT
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 56
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-0056
Mailing Address - Country:US
Mailing Address - Phone:787-854-5055
Mailing Address - Fax:787-767-8484
Practice Address - Street 1:J11 CALLE ELLIOT VELEZ
Practice Address - Street 2:URB ATENAS
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-4616
Practice Address - Country:US
Practice Address - Phone:787-854-5055
Practice Address - Fax:787-767-8484
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2018-04-24
Deactivation Date:2007-07-06
Deactivation Code:
Reactivation Date:2018-04-24
Provider Licenses
StateLicense IDTaxonomies
MDC15272222Z00000X, 224P00000X
DECPO02314222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist