1063596203 NPI number — MR. SAMUEL HERNANDEZ RESP. THERAPIST

Table of content: MR. SAMUEL HERNANDEZ RESP. THERAPIST (NPI 1063596203)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063596203 NPI number — MR. SAMUEL HERNANDEZ RESP. THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERNANDEZ
Provider First Name:
SAMUEL
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RESP. THERAPIST
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063596203
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MONTEPIEDRA ST. II13 URB. MONTE VERDE #3083
Provider Second Line Business Mailing Address:
3083
Provider Business Mailing Address City Name:
MANATI
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00674
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-884-6168
Provider Business Mailing Address Fax Number:
787-884-6168

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3083 CALLE MONTE PIEDRA
Provider Second Line Business Practice Location Address:
URB. MONTE VERDE
Provider Business Practice Location Address City Name:
MANATI
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00674-6329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-884-6168
Provider Business Practice Location Address Fax Number:
787-884-6168
Provider Enumeration Date:
10/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 247200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com