Provider Demographics
NPI:1144309329
Name:HERNANDEZ, MARTIN SR (MD)
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:
Last Name:HERNANDEZ
Suffix:SR
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:HC01 BOX 4070
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795
Mailing Address - Country:US
Mailing Address - Phone:787-260-0902
Mailing Address - Fax:
Practice Address - Street 1:MUNOZ RIVERA STREET #40
Practice Address - Street 2:CDT SAN CRISTOBAL VILLALBA
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766
Practice Address - Country:US
Practice Address - Phone:787-847-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9335208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
9335OtherPUERTO RICO LICENSE
13H1744374OtherNARCUTIC US LICENSE
9335OtherPUERTO RICO LICENSE
E84391Medicare UPIN