Provider Demographics
NPI:1366713901
Name:HERNANDEZ-KOZMA, NATALIE (MD)
Entity type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:
Last Name:HERNANDEZ-KOZMA
Suffix:
Gender:F
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:PO BOX 7436
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-7436
Mailing Address - Country:US
Mailing Address - Phone:787-652-4864
Mailing Address - Fax:787-652-4865
Practice Address - Street 1:740 AVE HOSTOS
Practice Address - Street 2:MEDICAL CENTER PLAZA, SUITE 305
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-1539
Practice Address - Country:US
Practice Address - Phone:787-652-4864
Practice Address - Fax:787-652-4865
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18, 380208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice