Provider Demographics
NPI:1043514110
Name:COFAN HERNANDEZ, MICHELLE
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:COFAN HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE RENO H24 VISTA BELLA BAYAMON PR 00956
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-4822
Mailing Address - Country:US
Mailing Address - Phone:787-798-7254
Mailing Address - Fax:787-798-7254
Practice Address - Street 1:CARR 2 # KM156.5
Practice Address - Street 2:1ST FLOOR OFFICE PARK IV BUILDING
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-6353
Practice Address - Country:US
Practice Address - Phone:787-292-7979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-05
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18102207R00000X, 208D00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice