Healthcare Provider Details

I. General information

NPI: 1265342091
Provider Name (Legal Business Name): JOSEPH FABIAN HERNANDEZ-QUILES RT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 CALLE 21
SAN JUAN PR
00924-1273
US

IV. Provider business mailing address

499 CALLE 21
SAN JUAN PR
00924-1273
US

V. Phone/Fax

Practice location:
  • Phone: 787-624-2922
  • Fax:
Mailing address:
  • Phone: 787-624-2922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number1016734
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: