=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609077882
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MIGUEL HERNANDEZ PEREZ SR. MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2007
-----------------------------------------------------
Last Update Date | 09/06/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1630 SANTA EDUBIJES SAGRADO CORAZON
-----------------------------------------------------
City | RIO PIEDRAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00927-0000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-760-1376
-----------------------------------------------------
Fax | 787-760-1376
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1630 SANTA EDUBIJES SAGRADO CORAZON
-----------------------------------------------------
City | RIO PIEDRAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00927-0000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-760-1376
-----------------------------------------------------
Fax | 787-760-1376
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number | 7502
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------