Provider Demographics
NPI:1528169737
Name:HERNANDEZ HERNANDEZ, MIRIAM (MD)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:HERNANDEZ HERNANDEZ
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 1:85 VILLAS DE SOTOMAYOR
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-2620
Mailing Address - Country:US
Mailing Address - Phone:787-868-7777
Mailing Address - Fax:787-868-7777
Practice Address - Street 1:CARR. 417 KM 3.0 BO. ASOMANTE
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:787-868-7777
Practice Address - Fax:787-868-7777
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15775208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR22975Medicare ID - Type UnspecifiedMEDICARE #