=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568421378
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EVAURELY HERNANDEZ M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CARR NUM 2 SECOND FLOOR HERMANOS MELENDEZ HOSP
-----------------------------------------------------
City | BAYAMON
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00956
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-787-7043
-----------------------------------------------------
Fax | 787-780-8091
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3916
-----------------------------------------------------
City | GUAYNABO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00970-3916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-999-0753
-----------------------------------------------------
Fax | 787-999-0790
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 12587
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------