Healthcare Provider Details

I. General information

NPI: 1912326752
Provider Name (Legal Business Name): GABRIEL HERNANDEZ MARTIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 06/17/2020
Certification Date: 06/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ASHFORD MEDICAL TOWER SUITE 805 29 WASHINGTON STREET
SAN JUAN PR
00907
US

IV. Provider business mailing address

PO BOX 362278
SAN JUAN PR
00936-2278
US

V. Phone/Fax

Practice location:
  • Phone: 787-721-6380
  • Fax:
Mailing address:
  • Phone: 787-721-6380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number21170
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number21170
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberE12141
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: