Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 746 | PR |
N | 2251H1200X | Hand | 746 | PR |
N | 2251N0400X | Physical Therapist - Neurology | 746 | PR |
N | 2251X0800X | Physical Therapist - Orthopedic | 746 | PR |
NPI | 1659937621 |
---|---|
Provider Name | Gloria Yolanda Hernandez |
First Address | Camuy, PR 00627-0077 |
Second Address | Camuy, PR 00627 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2019 |
Last Update Date | 15/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100002591 | CFSE (01) | PR |