Individual
DR. JORGE CARLOS ILLANAS HERNANDEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
PR #2 KM 156.7, MAYAGUEZ, PR 00680
(787) 380-8425
Mailing address
PO BOX 987, MAYAGUEZ, PR 00681-0987
(787) 380-8425
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
23145
PR
390200000X
Student in an Organized Health Care Education/Training Program
15878-I
PR
Other
Enumeration date
08/25/2022
Last updated
03/15/2023
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