MEDICARE: DR. MIGUEL HERNANDEZ PEREZ SR. 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	208D00000X	General Practice Physician	7502	PR

General Provider Information

NPI Number	:	1609077882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIGUEL HERNANDEZ PEREZ SR. MD

Provider Business Mailing Address
First Line	:	1630 SANTA EDUBIJES SAGRADO CORAZON
Second Line	:
City	:	RIO PIEDRAS
State	:	PR
Zip	:	00927-0000
Country	:	US
Telephone Number	:	787-760-1376
Fax Number	:	787-760-1376

Provider Business Practice Location Address
First Line	:	1630 SANTA EDUBIJES SAGRADO CORAZON
Second Line	:
City	:	RIO PIEDRAS
State	:	PR
Zip	:	00927-0000
Country	:	US
Telephone Number	:	787-760-1376
Fax Number	:	787-760-1376

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

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	09/06/2007

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