Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 16879 | PR |
NPI | 1043499445 |
---|---|
Provider Name | Dr. Johanny Hernandez |
First Address | San Juan, PR 00926-7011 |
Second Address | Guaynabo, PR 00969-5523 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2007 |
Last Update Date | 15/08/2014 |