Provider Demographics
NPI:1871176131
Name:HERNANDEZ ROSARIO, LIOCAR ZOEN (MD)
Entity type:Individual
Prefix:
First Name:LIOCAR
Middle Name:ZOEN
Last Name:HERNANDEZ ROSARIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. FAJARDO GARDENS STREET CEIBA #9
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PUERT RICO
Mailing Address - Zip Code:00738
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CARR. NUM 2 KM 11.9
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PUERTO RICO
Practice Address - Zip Code:00738
Practice Address - Country:UM
Practice Address - Phone:787-474-8282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-04
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23485208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6247460OtherDRIVING LICENSE