Provider Demographics
NPI:1063596203
Name:HERNANDEZ, SAMUEL (RESP THERAPIST)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:RESP THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MONTEPIEDRA ST. II13 URB. MONTE VERDE #3083
Mailing Address - Street 2:3083
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:787-884-6168
Mailing Address - Fax:787-884-6168
Practice Address - Street 1:3083 CALLE MONTE PIEDRA
Practice Address - Street 2:URB. MONTE VERDE
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-6329
Practice Address - Country:US
Practice Address - Phone:787-884-6168
Practice Address - Fax:787-884-6168
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other