Healthcare Provider Details

I. General information

NPI: 1548245939
Provider Name (Legal Business Name): FERNANDO GERENA NIEVES M.D ,D.A.B.A ,F.ABPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 CALLE LOS MANGOS CENTRO INT .DE MERCADEO 1 SUITE 301
CATANO PR
00962-5830
US

IV. Provider business mailing address

PO BOX 2793
GUAYNABO PR
00970-2793
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-9871
  • Fax: 787-641-9874
Mailing address:
  • Phone: 787-641-9871
  • Fax: 787-641-9874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number12238
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number12238
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: