Healthcare Provider Details

I. General information

NPI: 1184877235
Provider Name (Legal Business Name): CHRISTIAN HERNANDEZ NAZARIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2008
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W RIVER RD
WEWAHITCHKA FL
32465-4533
US

IV. Provider business mailing address

HC 3 BOX 29242-12
AGUADA PR
00602-9740
US

V. Phone/Fax

Practice location:
  • Phone: 850-639-5828
  • Fax: 850-639-5536
Mailing address:
  • Phone: 787-219-2432
  • Fax: 787-993-1793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number17375
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1156
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: