Healthcare Provider Details

I. General information

NPI: 1639701774
Provider Name (Legal Business Name): JOSE MIGUEL HERNANDEZ PUIG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 04/05/2025
Certification Date: 04/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PASEO DR. JOSE CELSO BARBOSA
SAN JUAN PR
00921
US

IV. Provider business mailing address

PO BOX 141044
ARECIBO PR
00614
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2525
  • Fax:
Mailing address:
  • Phone: 787-604-1904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number23964
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: