Healthcare Provider Details

I. General information

NPI: 1144309329
Provider Name (Legal Business Name): MARTIN HERNANDEZ SR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 09/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MUNOZ RIVERA STREET #40 CDT SAN CRISTOBAL VILLALBA
VILLALBA PR
00766
US

IV. Provider business mailing address

HC01 BOX 4070
JUANA DIAZ PR
00795
US

V. Phone/Fax

Practice location:
  • Phone: 787-847-3000
  • Fax:
Mailing address:
  • Phone: 787-260-0902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number9335
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: