Healthcare Provider Details

I. General information

NPI: 1821528035
Provider Name (Legal Business Name): MANUEL ENRIQUE HERNANDEZ PUIG JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 07/09/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CALLE HERNANDEZ CARRION STE 411
MANATI PR
00674-4652
US

IV. Provider business mailing address

PO BOX 141044
ARECIBO PR
00614-1044
US

V. Phone/Fax

Practice location:
  • Phone: 888-888-8888
  • Fax:
Mailing address:
  • Phone: 787-598-1033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number23654
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: