MEDICARE: DR. LEILA G HERNANDEZ PH.D

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	103TC0700X	Clinical Psychologist	00170	PR

General Provider Information

NPI Number	:	1598970493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEILA G HERNANDEZ PH.D

Provider Business Mailing Address
First Line	:	511 CALLE INDEPENDENCIA
Second Line	:	URB. LOS MAESTROS
City	:	SAN JUAN
State	:	PR
Zip	:	00918-3321
Country	:	US
Telephone Number	:	787-754-1449
Fax Number	:

Provider Business Practice Location Address
First Line	:	511 CALLE INDEPENDENCIA
Second Line	:	URB. LOS MAESTROS
City	:	SAN JUAN
State	:	PR
Zip	:	00918-3321
Country	:	US
Telephone Number	:	787-754-1449
Fax Number	:

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

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	07/08/2007

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