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General NPI Number Information
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NPI Number | 1104523067
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Entity Type | Individual
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Provider Name | JUAN ANTONIO ROSARIO HERNANDEZ LCDO
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Gender | Male
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Dates
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Enumeration Date | 02/10/2023
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Last Update Date | 02/10/2023
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Provider Practice Location Address
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Address Line | 432 PASEO DE LA VEGA
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City | VEGA ALTA
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State | PR
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Zip | 00692-7716
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Country | US
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Telephone | 787-702-4714
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Fax |
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Provider Business Mailing Address
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Address Line | 432 PASEO DE LA VEGA
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City | VEGA ALTA
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State | PR
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Zip | 00692-7716
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Country | US
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Telephone | 787-702-4714
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 22767
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License Number State | PR
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