Provider Demographics
NPI:1326849035
Name:HERNANDEZ BURGOS, KRYSTAL
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:HERNANDEZ BURGOS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:
Other - Last Name:HERNANDEZ BURGOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:133 COMUNIDAD ASOMANTE # 11
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-9448
Mailing Address - Country:US
Mailing Address - Phone:939-275-3834
Mailing Address - Fax:
Practice Address - Street 1:65 CALLE CABRERA, ESQUINA ANTONIO LOPEZ,HUMACAO PUEBLO
Practice Address - Street 2:65C11 LA CARRERA
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:939-275-3834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-20
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7551103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty