MEDICARE: DR. JOHANNY HERNANDEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center	16879	PR
2	208D00000X	General Practice Physician	16879	PR

General Provider Information

NPI Number	:	1043499445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHANNY HERNANDEZ

Provider Business Mailing Address
First Line	:	COND JARDINES DE MONTEHIEDRA
Second Line	:	AVE. LOS ROMEROS 1500 APT. 1007
City	:	SAN JUAN
State	:	PR
Zip	:	00926-7011
Country	:	US
Telephone Number	:	787-734-0459
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 AVE LAS CUMBRES
Second Line	:
City	:	GUAYNABO
State	:	PR
Zip	:	00969-5523
Country	:	US
Telephone Number	:	787-720-5050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2007
Last Update Date	:	08/15/2014

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