Healthcare Provider Details

I. General information

NPI: 1477236206
Provider Name (Legal Business Name): ANGELIS HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2023
Last Update Date: 08/09/2023
Certification Date: 08/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PARCELAS MORA GUERRERO CALLE 13 BUZON 439
ISABELA PR
00662
US

IV. Provider business mailing address

PARCELAS MORA GUERRERO CALLE 13 BUZON 439
ISABELA PR
00662
US

V. Phone/Fax

Practice location:
  • Phone: 787-421-3309
  • Fax:
Mailing address:
  • Phone: 787-421-3309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number6795
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: