Provider Demographics
NPI:1104523067
Name:ROSARIO HERNANDEZ, JUAN ANTONIO (LCDO)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:ANTONIO
Last Name:ROSARIO HERNANDEZ
Suffix:
Gender:M
Credentials:LCDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 PASEO DE LA VEGA
Mailing Address - Street 2:
Mailing Address - City:VEGA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00692-7716
Mailing Address - Country:US
Mailing Address - Phone:787-702-4714
Mailing Address - Fax:
Practice Address - Street 1:432 PASEO DE LA VEGA
Practice Address - Street 2:
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692-7716
Practice Address - Country:US
Practice Address - Phone:787-702-4714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR227671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical