Healthcare Provider Details

I. General information

NPI: 1679197404
Provider Name (Legal Business Name): CARLOS RICARDO HERNANDEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2020
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSPITAL BUEN SAMARITANO APARTADO 4055
AGUADILLA PR
00605
US

IV. Provider business mailing address

HC 3 BOX 11453
CAMUY PR
00627-9665
US

V. Phone/Fax

Practice location:
  • Phone: 787-658-0000
  • Fax:
Mailing address:
  • Phone: 787-309-0885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number23088
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number23088
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number15368-I
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: