Healthcare Provider Details

I. General information

NPI: 1245795087
Provider Name (Legal Business Name): GABRIEL ALEJANDRO HERNANDEZ ROMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

371 CALLE DE DIEGO
SAN JUAN PR
00923-3002
US

IV. Provider business mailing address

LM7 PARQUE DE LAS MODELOS
CAROLINA PR
00982
US

V. Phone/Fax

Practice location:
  • Phone: 787-225-4128
  • Fax:
Mailing address:
  • Phone: 787-225-4128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number23327
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: