Provider Demographics
NPI:1689412264
Name:HERNANDEZ, RAUL DAVID (PA)
Entity type:Individual
Prefix:
First Name:RAUL
Middle Name:DAVID
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:129 MISSISSIPPI STR
Mailing Address - Street 2:URB. EL PARAISO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-327-1804
Mailing Address - Fax:787-327-1804
Practice Address - Street 1:129 MISSISSIPPI STR
Practice Address - Street 2:URB. EL PARAISO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-3113
Practice Address - Country:US
Practice Address - Phone:787-327-1804
Practice Address - Fax:787-327-1804
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR001214363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical