Healthcare Provider Details

I. General information

NPI: 1972952224
Provider Name (Legal Business Name): AMYL HERNANDEZ ORTIZ MRC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 06/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HC 4 BOX 8040
AGUAS BUENAS PR
00703-8843
US

IV. Provider business mailing address

HC 4 BOX 8040
AGUAS BUENAS PR
00703-8843
US

V. Phone/Fax

Practice location:
  • Phone: 787-942-4589
  • Fax:
Mailing address:
  • Phone: 787-942-4589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number1576
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: