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General NPI Number Information
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NPI Number | 1932270667
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Entity Type | Individual
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Provider Name | WANDA NAZARIO DMD
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Gender | Female
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 10/30/2015
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Provider Practice Location Address
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Address Line | 100 GRAND PASEOS BLVD SUITE 112 PMB 150
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City | SAN JUAN
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State | PR
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Zip | 00926
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Country | US
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Telephone | 787-766-4979
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Fax |
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Provider Business Mailing Address
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Address Line | 100 GRAND PASEOS BLVD PMB 150 SUITE 112
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City | SAN JUAN
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State | PR
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Zip | 00926
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Country | US
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Telephone | 787-688-6361
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2123
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License Number State | PR
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