Healthcare Provider Details

I. General information

NPI: 1235735960
Provider Name (Legal Business Name): ANA NICOLLE HERNANDEZ ALEJANDRO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE. 65 DE INFANTERIA, KM. 12.3
CAROLINA PR
00985
US

IV. Provider business mailing address

657 CALLE LIRIO DE PAZ LAS FLORES DE MONTEHIEDRA
SAN JUAN PR
00926
US

V. Phone/Fax

Practice location:
  • Phone: 787-769-2477
  • Fax:
Mailing address:
  • Phone: 787-436-0089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number000748
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: