Healthcare Provider Details

I. General information

NPI: 1194784959
Provider Name (Legal Business Name): NEIXA L NAZARIO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSPITAL DAMAS 2213 PONCE BY PASS 5TH FLOOR
PONCE PR
00717-1318
US

IV. Provider business mailing address

PO BOX 3619
GUAYNABO PR
00970-3619
US

V. Phone/Fax

Practice location:
  • Phone: 787-259-4427
  • Fax: 787-841-7228
Mailing address:
  • Phone: 787-999-0753
  • Fax: 787-999-0790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number11420
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: