Healthcare Provider Details

I. General information

NPI: 1922084110
Provider Name (Legal Business Name): PEDRO ANTONIO HERNANDEZ-NEVAREZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 CALLE CONVENTO
SAN JUAN PR
00912-3207
US

IV. Provider business mailing address

PO BOX 362618
SAN JUAN PR
00936-2618
US

V. Phone/Fax

Practice location:
  • Phone: 787-724-1112
  • Fax:
Mailing address:
  • Phone: 787-724-1112
  • Fax: 787-724-1106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number7211
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: