MEDICARE: NEFRO, PSC

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	261QM2500X	Medical Specialty Clinic/Center	9074	PR

General Provider Information

NPI Number	:	1124262977
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEFRO, PSC

Provider Business Mailing Address
First Line	:	PO BOX 191018
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00919-1018
Country	:	US
Telephone Number	:	787-344-3166
Fax Number	:

Provider Business Practice Location Address
First Line	:	HOSPITAL SAN JUAN BAUTISTA
Second Line	:	PISO 3 UNIDAD DE DIALISIS
City	:	CAGUAS
State	:	PR
Zip	:	00726-4964
Country	:	US
Telephone Number	:	787-344-3166
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. ADAIR ANGEL LABOY
Credential	:
Telephone Number	:	787-344-3166

Provider Enumeration Date	:	04/23/2009
Last Update Date	:	04/23/2009

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