MEDICARE: NELLY IVELISSE CATALA DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2286	PR

General Provider Information

NPI Number	:	1104813690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NELLY IVELISSE CATALA DMD

Provider Business Mailing Address
First Line	:	PO BOX 2735
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00960-2735
Country	:	US
Telephone Number	:	787-740-1919
Fax Number	:	787-785-8688

Provider Business Practice Location Address
First Line	:	AVE LAS MILLONES D-95
Second Line	:	REPTO ALHAMBRA
City	:	BAYAMON
State	:	PR
Zip	:	00957
Country	:	US
Telephone Number	:	787-740-1919
Fax Number	:	787-785-8688

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	07/08/2007

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