Healthcare Provider Details

I. General information

NPI: 1396753208
Provider Name (Legal Business Name): RAYDA NANETTE HERNANDEZ-GUASCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SANTA CRUZ ST #64 GALERIA MEDICA SUITE 104
BAYAMON PR
00961-7001
US

IV. Provider business mailing address

PMB 525 #89 DE DIEGO AVE SUITE 105
SAN JUAN PR
00927-5831
US

V. Phone/Fax

Practice location:
  • Phone: 787-269-2250
  • Fax: 787-269-2295
Mailing address:
  • Phone: 787-269-2250
  • Fax: 787-269-2295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number7493
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: