Provider Demographics
NPI:1992092209
Name:HERNANDEZ FLORES, WALDEMAR (ADN)
Entity type:Individual
Prefix:MR
First Name:WALDEMAR
Middle Name:
Last Name:HERNANDEZ FLORES
Suffix:
Gender:M
Credentials:ADN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 64 BOX 6673
Mailing Address - Street 2:
Mailing Address - City:PATILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00723-9709
Mailing Address - Country:US
Mailing Address - Phone:787-381-9040
Mailing Address - Fax:787-733-1655
Practice Address - Street 1:CARR. 198 KM 22.0
Practice Address - Street 2:BO. MONTONES I
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771-0000
Practice Address - Country:US
Practice Address - Phone:787-716-0050
Practice Address - Fax:787-733-1655
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10403164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR10403OtherLICENCIA PROFECIONAL