Healthcare Provider Details

I. General information

NPI: 1497968143
Provider Name (Legal Business Name): NESTOR E AMADOR-CHACON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB FLAMBOYAN MARGINAL SUR B-11
MANATI PR
00674-1144
US

IV. Provider business mailing address

PO BOX 1144
MANATI PR
00674-1144
US

V. Phone/Fax

Practice location:
  • Phone: 787-854-4064
  • Fax:
Mailing address:
  • Phone: 787-244-8136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number13100
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number13100
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: