Healthcare Provider Details

I. General information

NPI: 1295861284
Provider Name (Legal Business Name): LIZA M HERNANDEZ-GONZALEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 AVE ANDALUCIA
SAN JUAN PR
00920-5311
US

IV. Provider business mailing address

640 AVE ANDALUCIA
SAN JUAN PR
00920-5311
US

V. Phone/Fax

Practice location:
  • Phone: 787-957-5553
  • Fax: 787-957-5710
Mailing address:
  • Phone: 787-957-5553
  • Fax: 787-957-5510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number15978
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number15978
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: