Provider Demographics
NPI:1730425323
Name:HERNANDEZ, JUAN E (MD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:E
Last Name:HERNANDEZ
Suffix:
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:PO BOX 1993
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-1993
Mailing Address - Country:US
Mailing Address - Phone:787-239-9143
Mailing Address - Fax:787-872-9216
Practice Address - Street 1:CARR #2 (MARGINAL) KM 119.2
Practice Address - Street 2:BO CAIMITAL ALTO
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-658-7111
Practice Address - Fax:787-658-7122
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-31
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR020270208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice