MEDICARE: DR. MICHAEL HERNANDEZ DE LA FUENTE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	14361	PR

General Provider Information

NPI Number	:	1649269820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL HERNANDEZ DE LA FUENTE M.D.

Provider Business Mailing Address
First Line	:	CENTRO INTERNACIONAL DE MERCADEO 100 CARR. 165
Second Line	:	STE. 303
City	:	GUAYNABO
State	:	PR
Zip	:	00968
Country	:	US
Telephone Number	:	787-277-0847
Fax Number	:	787-277-0942

Provider Business Practice Location Address
First Line	:	CENTRO INTERNACIONAL DE MERCADEO 100 CARR. 165
Second Line	:	STE. 303
City	:	GUAYNABO
State	:	PR
Zip	:	00968
Country	:	US
Telephone Number	:	787-277-0847
Fax Number	:	787-277-0942

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	09/19/2012

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