Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 6061 | PR |
NPI | 1164575460 |
---|---|
Provider Name | Gloria Esther Hernandez |
First Address | San Lorenzo, PR 00754 |
Second Address | San Lorenzo, PR 00754 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2007 |
Last Update Date | 08/07/2007 |