Healthcare Provider Details

I. General information

NPI: 1629592936
Provider Name (Legal Business Name): DAVID HERNANDEZ RIVERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2017
Last Update Date: 01/17/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 AVE PONCE DE LEON HOSPITAL AUXILIO MUTUO
SAN JUAN PR
00917-5032
US

IV. Provider business mailing address

PO BOX 191227
SAN JUAN PR
00919-1227
US

V. Phone/Fax

Practice location:
  • Phone: 787-758-2000
  • Fax:
Mailing address:
  • Phone: 787-758-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22335
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: