MEDICARE: LIOCAR ZOEN HERNANDEZ ROSARIO 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	23485	PR
2	390200000X	Student in an Organized Health Care Education/Training Program	23485	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6247460	OTHER	PR	DRIVING LICENSE

General Provider Information

NPI Number	:	1871176131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIOCAR ZOEN HERNANDEZ ROSARIO MD

Provider Business Mailing Address
First Line	:	URB. FAJARDO GARDENS STREET CEIBA #9
Second Line	:
City	:	FAJARDO
State	:	PUERT RICO
Zip	:	00738
Country	:	UM
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 SECTOR CUESTAS LOS JOBOS
Second Line	:
City	:	HUMACAO
State	:	PUERTO RICO
Zip	:	00791
Country	:	UM
Telephone Number	:	787-474-8282
Fax Number	:

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

Provider Enumeration Date	:	05/04/2021
Last Update Date	:	06/08/2026

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