Provider Demographics
NPI:1063521912
Name:GOMEZ HERNANDEZ, JUAN SANTOS (MD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:SANTOS
Last Name:GOMEZ HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:URB PASEOS DE JACARANDA
Mailing Address - Street 2:15049 CALLE UCAR
Mailing Address - City:SANTA ISABEL
Mailing Address - State:PR
Mailing Address - Zip Code:00757
Mailing Address - Country:US
Mailing Address - Phone:787-415-4622
Mailing Address - Fax:787-656-9392
Practice Address - Street 1:URB JARDINES DE YABUCOA
Practice Address - Street 2:B8 CALLE 3
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767
Practice Address - Country:US
Practice Address - Phone:787-690-8280
Practice Address - Fax:787-656-9392
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR15478208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR101124OtherCRUZ AZUL
PR400309OtherMMM
PR7710000OtherHUMANA HEALTH PLAN
PR22891-GOOtherTRIPLE-S
PR581910517OtherMAPFRE
PR7710000OtherHUMANA HEALTH PLAN
PR581910517OtherMAPFRE