Healthcare Provider Details

I. General information

NPI: 1396182861
Provider Name (Legal Business Name): VICTOR FERNANDO NAZARIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2013
Last Update Date: 03/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 HOSTOS AVE.
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

PO BOX 3306
MAYAGUEZ PR
00681-3306
US

V. Phone/Fax

Practice location:
  • Phone: 787-832-1710
  • Fax:
Mailing address:
  • Phone: 732-874-1247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice
License Number19000
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: