Healthcare Provider Details

I. General information

NPI: 1861882904
Provider Name (Legal Business Name): NYLMARIS MUNOZ NEGRON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE LUIS MUOZ RIVERA #3 BO. ESPINOSA
VEGA ALTA PR
00692
US

IV. Provider business mailing address

PO BOX 4317
VEGA BAJA PR
00694-4317
US

V. Phone/Fax

Practice location:
  • Phone: 787-883-0124
  • Fax: 787-883-0222
Mailing address:
  • Phone: 787-883-0124
  • Fax: 787-883-0222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number21274
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: