MEDICARE: JORGE NEVAREZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	4834235	ZZ

General Provider Information

NPI Number	:	1083072102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORGE NEVAREZ

Provider Business Mailing Address
First Line	:	7362 REMCON CIR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-1623
Country	:	US
Telephone Number	:	915-727-2495
Fax Number	:	915-996-9405

Provider Business Practice Location Address
First Line	:	HERMANOS ESCOBAR # 2703-1
Second Line	:
City	:	CD. JUAREZ
State	:	CHIHUAHUA
Zip	:	32300
Country	:	MX
Telephone Number	:	915-727-2495
Fax Number	:	915-996-9405

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2016
Last Update Date	:	02/03/2016

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Directions to “ JORGE NEVAREZ ” Practice Location

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