Provider Demographics
NPI:1184877235
Name:HERNANDEZ NAZARIO, CHRISTIAN (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:
Last Name:HERNANDEZ NAZARIO
Suffix:
Gender:M
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:HC 3 BOX 29242-12
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-9740
Mailing Address - Country:US
Mailing Address - Phone:787-219-2432
Mailing Address - Fax:787-993-1793
Practice Address - Street 1:255 W RIVER RD
Practice Address - Street 2:
Practice Address - City:WEWAHITCHKA
Practice Address - State:FL
Practice Address - Zip Code:32465-4533
Practice Address - Country:US
Practice Address - Phone:850-639-5828
Practice Address - Fax:850-639-5536
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-01
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17375208D00000X
FLACN1156208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103209200Medicaid