Provider Demographics
NPI:1265586200
Name:HERNANDEZ, JUANITA (MD)
Entity type:Individual
Prefix:DR
First Name:JUANITA
Middle Name:
Last Name: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:PO BOX 487
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-0487
Mailing Address - Country:US
Mailing Address - Phone:787-733-2716
Mailing Address - Fax:
Practice Address - Street 1:CARR, 926 KM. 0.4
Practice Address - Street 2:BO. COLLORES
Practice Address - City:LAS PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00771
Practice Address - Country:US
Practice Address - Phone:787-733-2716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5485207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR68278OtherCRUZ AZUL
PR8098OtherIMC
PR055246029OtherCIGNA
PR26937HEOtherSSS
PR500001SEOtherMMM
PR28695OtherAMPR
PR7710008OtherHUMANA
PR26937Medicare ID - Type Unspecified