Healthcare Provider Details

I. General information

NPI: 1083944730
Provider Name (Legal Business Name): SONIA HERNANDEZ GOMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2009
Last Update Date: 12/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB VILLA MARINA BAHIA SUR A7
GURABO PR
00778
US

IV. Provider business mailing address

URB VILLA MARINA BAHIA SUR A7
GURABO PR
00778-0448
US

V. Phone/Fax

Practice location:
  • Phone: 787-375-1336
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number58478931
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: