Provider Demographics
NPI:1972952224
Name:HERNANDEZ ORTIZ, AMYL (MRC)
Entity type:Individual
Prefix:
First Name:AMYL
Middle Name:
Last Name:HERNANDEZ ORTIZ
Suffix:
Gender:M
Credentials:MRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 4 BOX 8040
Mailing Address - Street 2:
Mailing Address - City:AGUAS BUENAS
Mailing Address - State:PR
Mailing Address - Zip Code:00703-8843
Mailing Address - Country:US
Mailing Address - Phone:787-942-4589
Mailing Address - Fax:
Practice Address - Street 1:HC 4 BOX 8040
Practice Address - Street 2:
Practice Address - City:AGUAS BUENAS
Practice Address - State:PR
Practice Address - Zip Code:00703-8843
Practice Address - Country:US
Practice Address - Phone:787-942-4589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1576225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor