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General NPI Number Information
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NPI Number | 1700481405
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Entity Type | Individual
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Provider Name | OLGA ALICIA GERENA HERNANDEZ PA
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Gender | Female
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Dates
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Enumeration Date | 12/01/2020
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Last Update Date | 12/01/2020
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Provider Practice Location Address
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Address Line | CARR. #906 KM. 11.5 COCONUT GROVE PLAZA LOCAL 4
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City | HUMACAO
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State | PR
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Zip | 00791
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Country | US
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Telephone | 787-850-4515
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Fax |
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Provider Business Mailing Address
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Address Line | CALLE 3 #F30 VILLAS DE LOIZA
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City | CANOVANAS
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State | PR
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Zip | 00729-4212
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Country | US
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Telephone | 787-408-6818
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 785
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License Number State | PR
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