Healthcare Provider Details

I. General information

NPI: 1205038973
Provider Name (Legal Business Name): CARLOS JUAN HERNANDEZ SOCIAL WORKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CENTRO SALUD MENTAL DE MAYAGUEZ AVE HOSTOS 410 SUITE 7
MAYAGUEZ PR
00682-1522
US

IV. Provider business mailing address

URB. RAMIREZ DE ARRELLANO CALLEYTANO COLL Y TOSTE #12
MAYAGUEZ PR
00680
US

V. Phone/Fax

Practice location:
  • Phone: 787-833-0663
  • Fax: 787-831-1371
Mailing address:
  • Phone: 787-831-4086
  • Fax: 787-833-1371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number8404
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: