Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 13937 | PR |
NPI | 1023021730 |
---|---|
Provider Name | Dr. Wilfredo Hernandez |
First Address | Mayaguez, PR 00681-7147 |
Second Address | Cabo Rojo, PR 00623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H75248 | (02) | PR |