Healthcare Provider Details

I. General information

NPI: 1235100777
Provider Name (Legal Business Name): MARIO R. NEVAREZ ALONSO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 12/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 CALLE SAN JORGE SAN JORGE MEDICAL OFFICE BLDG. SUITE 406
SAN JUAN PR
00912-3310
US

IV. Provider business mailing address

325 BLVD. MEDIA LUNA COND. BRISAS DE PARQUE ESCORIAL APT. 2904
CAROLINA PR
00987-5150
US

V. Phone/Fax

Practice location:
  • Phone: 787-726-0210
  • Fax:
Mailing address:
  • Phone: 787-281-0643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number10845
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: