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General NPI Number Information
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NPI Number | 1447714712
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Entity Type | Individual
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Provider Name | REY LUIS HERNANDEZ RODRIGUEZ
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Gender | Male
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Dates
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Enumeration Date | 01/30/2019
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Last Update Date | 06/21/2022
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Provider Practice Location Address
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Address Line | 251 E HURON ST
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City | CHICAGO
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State | IL
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Zip | 60611-2908
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Country | US
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Telephone | 787-469-4786
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Fax |
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Provider Business Mailing Address
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Address Line | CALLE 20 W 37 VILLA NUEVA
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City | CAGUAS
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State | PR
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Zip | 00727-6947
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Country | US
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Telephone | 787-469-4786
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 35628
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License Number State | PR
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 125.079185
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License Number State | IL
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