Healthcare Provider Details

I. General information

NPI: 1710020409
Provider Name (Legal Business Name): RUTILIO HERNANDEZ CEREZO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 11/25/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE AGUSTIN RAMOS CALERO KM 1.4
ISABELA PR
00662
US

IV. Provider business mailing address

PO BOX 3613
AGUADILLA PR
00605-3613
US

V. Phone/Fax

Practice location:
  • Phone: 787-830-2705
  • Fax: 787-830-3059
Mailing address:
  • Phone: 787-830-2705
  • Fax: 787-830-3059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number12007
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: