Healthcare Provider Details

I. General information

NPI: 1174725014
Provider Name (Legal Business Name): NAYDA M NICOLAU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 ST VALPARAISO B 19
TOA BAJA PR
00949
US

IV. Provider business mailing address

VALPARAISO 10TH ST B 19
TOA BAJA PR
00949
US

V. Phone/Fax

Practice location:
  • Phone: 787-784-8472
  • Fax: 787-784-0620
Mailing address:
  • Phone: 787-784-8472
  • Fax: 787-784-0620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number4680
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: