Provider Demographics
NPI:1962576793
Name:HERNANDEZ, HECTOR R SR (MD)
Entity type:Individual
Prefix:MR
First Name:HECTOR
Middle Name:R
Last Name:HERNANDEZ
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 50905
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-0905
Mailing Address - Country:US
Mailing Address - Phone:787-767-4250
Mailing Address - Fax:787-767-4252
Practice Address - Street 1:431 AVE PONCE DE LEON
Practice Address - Street 2:SUITE 901 EDIF NATIONAL PLAZA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-3418
Practice Address - Country:US
Practice Address - Phone:787-767-4250
Practice Address - Fax:787-767-4252
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4189207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D48280Medicare UPIN
0025182Medicare ID - Type Unspecified