Provider Demographics
NPI:1801811286
Name:HERNANDEZ, FERMIN (MD)
Entity type:Individual
Prefix:DR
First Name:FERMIN
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:FERMIN
Other - Middle Name:
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8064 PASAEO LAS GAVIOTAS URBANICACION CAMINO DEL MAR
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-784-8139
Mailing Address - Fax:787-784-8139
Practice Address - Street 1:8064 PASEO LAS GAVIOTAS URB. CAMINO DEL MAR
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-784-8139
Practice Address - Fax:787-784-8139
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11165146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0089400Medicare ID - Type Unspecified
PRG65056Medicare UPIN