Basic Information
| Provider Information | |||||||||
| NPI: | 1396881470 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERNANDEZ - SUCARICHI | ||||||||
| FirstName: | JORGE | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 70344 | ||||||||
| Address2: | PMB 193 | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009368344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876176298 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | CENTRO DE TAUMA ASEM | ||||||||
| Address2: | CENTRO MEDICO DE PR BO MONACILLOS | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877773760 | ||||||||
| FaxNumber: | 7877773781 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 07/17/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0127X | 5635 | PR | Y | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | 208600000X | 5635 | PR | N | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 04763-DM-9 | 01 | STATE NARCOTICS | OTHER | 5635 | 01 | PUERTO RICO | OTHER | 27353-HE | 01 | SSS | OTHER | AH-9366356 | 01 | FEDERAL NARCOTICS | OTHER |