MEDICARE: DR. GABRIEL HERNANDEZ DENTON MD

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	174400000X	Specialist	6504	PR

General Provider Information

NPI Number	:	1215903026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GABRIEL HERNANDEZ DENTON MD

Provider Business Mailing Address
First Line	:	1475 CALLE WILSON
Second Line	:	SUITE 3B
City	:	SAN JUAN
State	:	PR
Zip	:	00907-2357
Country	:	US
Telephone Number	:	787-726-7380
Fax Number	:	787-268-1439

Provider Business Practice Location Address
First Line	:	1475 CALLE WILSON
Second Line	:	SUITE 3B
City	:	SAN JUAN
State	:	PR
Zip	:	00907-2357
Country	:	US
Telephone Number	:	787-726-7380
Fax Number	:	787-268-1439

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

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	02/02/2010

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