Healthcare Provider Details

I. General information

NPI: 1366487597
Provider Name (Legal Business Name): DR. SYLVIA MONSERRATE NUNEZ FIDALGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 CALLE CERRA ESQ CALLE HOARE PDA 15
SAN JUAN PR
00907-5104
US

IV. Provider business mailing address

URB. VALPARAISO CALLE 3 J-6
TOA BAJA PR
00940-4040
US

V. Phone/Fax

Practice location:
  • Phone: 787-977-0520
  • Fax:
Mailing address:
  • Phone: 787-315-2879
  • Fax: 787-261-6530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number14729
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: