Healthcare Provider Details

I. General information

NPI: 1821044785
Provider Name (Legal Business Name): GLADYS MARIA NEVAREZ MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CALLE 1
GUAYNABO PR
00966-1600
US

IV. Provider business mailing address

600 CALLE 1
GUAYNABO PR
00966-1600
US

V. Phone/Fax

Practice location:
  • Phone: 787-793-5184
  • Fax:
Mailing address:
  • Phone: 787-793-5184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5416
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: