Healthcare Provider Details

I. General information

NPI: 1609760024
Provider Name (Legal Business Name): FELIX JAVIER HERNANDEZ NIEVES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 06/15/2025
Certification Date: 06/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

917 AVE TITO CASTRO
PONCE PR
00716-4717
US

IV. Provider business mailing address

171 S ORLANDO AVE STE C
MAITLAND FL
32751-5653
US

V. Phone/Fax

Practice location:
  • Phone: 787-844-2080
  • Fax:
Mailing address:
  • Phone: 203-214-7794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number37580R
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: