Healthcare Provider Details

I. General information

NPI: 1487563078
Provider Name (Legal Business Name): PEDRO J HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 CALLE DR GONZALEZ
ISABELA PR
00662-2633
US

IV. Provider business mailing address

133 CALLE DR GONZALEZ
ISABELA PR
00662-2633
US

V. Phone/Fax

Practice location:
  • Phone: 787-872-8365
  • Fax:
Mailing address:
  • Phone: 787-872-8365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number7703
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: