Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 3195 | PR |
NPI | 1114225232 |
---|---|
Provider Name | Dr. Micol Hernandez Rivera |
First Address | San Juan, PR 00911-1873 |
Second Address | San Juan, PR 00911-1873 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2011 |
Last Update Date | 26/04/2021 |