Healthcare Provider Details

I. General information

NPI: 1699814657
Provider Name (Legal Business Name): GRUPO FISIATRICO HERNANDEZ DE LA FUENTE CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 09/02/2025
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CARR 165 STE 303 CENTRO INTERNACIONAL DE MERCADEO
GUAYNABO PR
00968-8049
US

IV. Provider business mailing address

100 CARR 165 STE 303 CENTRO INTERNACIONAL DE MERCADEO
GUAYNABO PR
00968-8049
US

V. Phone/Fax

Practice location:
  • Phone: 787-277-0871
  • Fax: 787-277-0942
Mailing address:
  • Phone: 787-277-0871
  • Fax: 787-277-0942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL HERNANDEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 787-277-0871