Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 000066 | PR |
NPI | 1245335306 |
---|---|
Provider Name | Carlos Hernandez Ortiz |
First Address | Bayamon, PR 00961-3114 |
Second Address | Bayamon, PR 00961-3114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U62114 | (02) | PR |