Basic Information
Provider Information
NPI: 1225080880
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HERNANDEZ LEBRON
FirstName: GIOVAN
MiddleName: E
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: URB CUIDAD JARDIN 51 CALLE SIEMPREVIVA
Address2:  
City: GURABO
State: PR
PostalCode: 007780000
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: GRUPO MEDICO SAMARITANO
Address2: BARRIO BARRAZAS CARR 182 KM 3
City: CAROLINA
State: PR
PostalCode: 009810000
CountryCode: US
TelephoneNumber: 7876611070
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/16/2006
LastUpdateDate: 03/09/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208D00000X13955PRY Allopathic & Osteopathic PhysiciansGeneral Practice 

No ID Information.


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