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General NPI Number Information
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NPI Number | 1356150783
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Entity Type | Individual
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Provider Name | JOSE GABRIEL HERNANDEZ SR. PA
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Gender | Male
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Dates
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Enumeration Date | 12/31/2024
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Last Update Date | 12/31/2024
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Provider Practice Location Address
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Address Line | HOSPITAL MENONITA CIDRA OFICINA 105
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City | CIDRA
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State | PR
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Zip | 00739
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Country | US
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Telephone | 787-739-6688
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Fax |
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Provider Business Mailing Address
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Address Line | HC 44 BOX 13436
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City | CAYEY
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State | PR
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Zip | 00736-9763
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Country | US
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Telephone | 939-381-0142
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 2448-PA
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2448-PA
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License Number State | PR
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