Healthcare Provider Details

I. General information

NPI: 1477547420
Provider Name (Legal Business Name): MANUEL NAREDO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 CALLE JOSE PADIN
SAN JUAN PR
00918-2415
US

IV. Provider business mailing address

PO BOX 191918
SAN JUAN PR
00919-1918
US

V. Phone/Fax

Practice location:
  • Phone: 787-754-6187
  • Fax:
Mailing address:
  • Phone: 787-792-6145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number7133
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: