Healthcare Provider Details

I. General information

NPI: 1023095973
Provider Name (Legal Business Name): ROBERTO LUIS NEVARES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 WASHINGTON ST STE 203
SAN JUAN PR
00907-1509
US

IV. Provider business mailing address

29 WASHINGTON ST STE 203
SAN JUAN PR
00907-1509
US

V. Phone/Fax

Practice location:
  • Phone: 787-722-6220
  • Fax: 787-722-4950
Mailing address:
  • Phone: 787-722-6220
  • Fax: 787-722-4950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number6844
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number6844
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: