1306123500 NPI number — ERIC GILBERTO HERNANDEZ-ORTIZ MD

Table of content: ERIC GILBERTO HERNANDEZ-ORTIZ MD (NPI 1306123500)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306123500 NPI number — ERIC GILBERTO HERNANDEZ-ORTIZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERNANDEZ-ORTIZ
Provider First Name:
ERIC
Provider Middle Name:
GILBERTO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1306123500
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
299 CALLE PIO BAROJA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00926-6903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-678-4092
Provider Business Mailing Address Fax Number:
939-731-3926

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
LIBERTY OFFICE PLAZA SUITE 2
Provider Second Line Business Practice Location Address:
CARR. 735 KM 0.5
Provider Business Practice Location Address City Name:
CAYEY
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-678-4092
Provider Business Practice Location Address Fax Number:
939-731-3926
Provider Enumeration Date:
11/16/2011

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: 207X00000X , with the licence number:  21080 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 038712700 , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".
  • Identifier: C04YK . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 020791500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: JA239Z . This is a "MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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