Healthcare Provider Details

I. General information

NPI: 1275637332
Provider Name (Legal Business Name): NICOLAS HERNANDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EL MONTE MALL STE 302
SAN JUAN PR
00918-4257
US

IV. Provider business mailing address

EL MONTE MALL STE 302
SAN JUAN PR
00918-4257
US

V. Phone/Fax

Practice location:
  • Phone: 787-764-0937
  • Fax:
Mailing address:
  • Phone: 787-764-0937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number12019
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: