Healthcare Provider Details

I. General information

NPI: 1164568390
Provider Name (Legal Business Name): MRS. JUANITA HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

APARTADO 515
NARANJITO PR
00719
US

IV. Provider business mailing address

HC 02 BOX 7213
COMERIO PR
00782
US

V. Phone/Fax

Practice location:
  • Phone: 787-869-5900
  • Fax:
Mailing address:
  • Phone: 787-875-6121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number3194
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: