Provider Demographics
NPI:1730233420
Name:HERNANDEZ, VICTOR RAFAEL (DMD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:RAFAEL
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:VICTOR
Other - Middle Name:R
Other - Last Name:HERNANDEZ-MENDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:667 CALLE LA PAZ
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-3508
Mailing Address - Country:US
Mailing Address - Phone:787-723-9947
Mailing Address - Fax:787-723-9948
Practice Address - Street 1:667 CALLE LA PAZ
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-3508
Practice Address - Country:US
Practice Address - Phone:787-723-9947
Practice Address - Fax:787-723-9948
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice