MEDICARE: DR. JUAN DIEGO HERNANDEZ D.M.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	1223G0001X	General Practice Dentistry	1477	PR

General Provider Information

NPI Number	:	1851396584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN DIEGO HERNANDEZ D.M.D

Provider Business Mailing Address
First Line	:	PO BOX 390
Second Line	:
City	:	VEGA ALTA
State	:	PR
Zip	:	00692-0390
Country	:	US
Telephone Number	:	787-858-2744
Fax Number	:	787-858-2744

Provider Business Practice Location Address
First Line	:	EXTENCION BETANCES #181
Second Line	:	ROAD 155 KM.66.8
City	:	VEGA BAJA
State	:	PR
Zip	:	00693
Country	:	US
Telephone Number	:	787-858-2744
Fax Number	:	787-858-2744

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	04/22/2009

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