Provider Demographics
NPI:1306123500
Name:HERNANDEZ-ORTIZ, ERIC GILBERTO (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:GILBERTO
Last Name:HERNANDEZ-ORTIZ
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 1:299 CALLE PIO BAROJA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6903
Mailing Address - Country:US
Mailing Address - Phone:787-678-4092
Mailing Address - Fax:939-731-3926
Practice Address - Street 1:LIBERTY OFFICE PLAZA SUITE 2
Practice Address - Street 2:CARR. 735 KM 0.5
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-678-4092
Practice Address - Fax:939-731-3926
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21080207X00000X
FLME132137207X00000X
PAMT200412208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR038712700Medicaid
FLC04YKOtherBCBS
FL020791500Medicaid
FLJA239ZOtherMEDICARE