Provider Demographics
NPI:1538392980
Name:HERNANDEZ, WANDA LIZ (MD)
Entity type:Individual
Prefix:DR
First Name:WANDA
Middle Name:LIZ
Last Name:HERNANDEZ
Suffix:
Gender:F
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:PO BOX 907
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-0907
Mailing Address - Country:US
Mailing Address - Phone:787-898-4190
Mailing Address - Fax:787-262-3984
Practice Address - Street 1:116 AVE DR SUSONI
Practice Address - Street 2:
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659-1847
Practice Address - Country:US
Practice Address - Phone:787-898-4190
Practice Address - Fax:787-262-3984
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17749208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice