=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457066821
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MANUEL NAREDO MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2023
-----------------------------------------------------
Last Update Date | 01/19/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1618 AVENIDA JESUS T. PINEIRO
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00921-1423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-792-6145
-----------------------------------------------------
Fax | 787-782-2774
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 191918
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00919-1918
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-792-6145
-----------------------------------------------------
Fax | 787-782-2774
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROPRIETOR-OWNER DIRECTOR
-----------------------------------------------------
Name | MR. MANUEL NAREDO
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 787-792-6145
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------