MEDICARE: DR. CARLOS RICARDO HERNANDEZ 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	390200000X	Student in an Organized Health Care Education/Training Program	15368-I	PR
2	208D00000X	General Practice Physician	23088	PR

General Provider Information

NPI Number	:	1679197404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLOS RICARDO HERNANDEZ MD

Provider Business Mailing Address
First Line	:	HC 3 BOX 11453
Second Line	:
City	:	CAMUY
State	:	PR
Zip	:	00627-9665
Country	:	US
Telephone Number	:	787-309-0885
Fax Number	:

Provider Business Practice Location Address
First Line	:	HOSPITAL BUEN SAMARITANO
Second Line	:	APARTADO 4055
City	:	AGUADILLA
State	:	PR
Zip	:	00605
Country	:	US
Telephone Number	:	787-658-0000
Fax Number	:

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

Provider Enumeration Date	:	06/08/2020
Last Update Date	:	02/24/2023

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Directions to “ DR. CARLOS RICARDO HERNANDEZ MD” Practice Location

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