Provider Demographics
NPI:1386075232
Name:HERNANDEZ, ELIZABETH (MT)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. JARDINES DE VEGA BAJA
Mailing Address - Street 2:292 CALLE JARDIN DEL CARIBE
Mailing Address - City:VEGA BAJA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00693
Mailing Address - Country:UM
Mailing Address - Phone:787-871-0601
Mailing Address - Fax:787-871-3960
Practice Address - Street 1:CARR. 149 KM12.2
Practice Address - Street 2:
Practice Address - City:CIALES
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00638
Practice Address - Country:UM
Practice Address - Phone:787-871-0601
Practice Address - Fax:787-871-3960
Is Sole Proprietor?:No
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3662246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other