Healthcare Provider Details

I. General information

NPI: 1891774428
Provider Name (Legal Business Name): HUMBERTO HERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COMDT(CG-1122) 2100 SECOND ST SW ROOM 5314
WASHINGTON DC
20593-0001
US

IV. Provider business mailing address

COMDT(CG-1122) 2100 SECOND ST SW ROOM 5314
WASHINGTON DC
20593-0001
US

V. Phone/Fax

Practice location:
  • Phone: 787-729-2305
  • Fax:
Mailing address:
  • Phone: 787-729-2305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10478
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: