Provider Demographics
NPI:1316562382
Name:HERNANDEZ HERNANDEZ, CRISTAL IMAR
Entity type:Individual
Prefix:
First Name:CRISTAL
Middle Name:IMAR
Last Name:HERNANDEZ 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:PO BOX 611
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-0611
Mailing Address - Country:US
Mailing Address - Phone:787-329-2499
Mailing Address - Fax:
Practice Address - Street 1:7125 13TH PL NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-2351
Practice Address - Country:US
Practice Address - Phone:202-545-2532
Practice Address - Fax:202-545-2543
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD210002756207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)