MEDICARE: NEFROLOGOS ASOCIADOS DEL NORTE, LLC

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	207RN0300X	Nephrology Physician

General Provider Information

NPI Number	:	1184729428
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEFROLOGOS ASOCIADOS DEL NORTE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 141030
Second Line	:
City	:	ARECIBO
State	:	PR
Zip	:	00614-1030
Country	:	US
Telephone Number	:	787-879-3828
Fax Number	:	787-878-6791

Provider Business Practice Location Address
First Line	:	65 CELSO BARBOSA
Second Line	:	SUITE 107
City	:	ARECIBO
State	:	PR
Zip	:	00612
Country	:	US
Telephone Number	:	787-879-3828
Fax Number	:	787-878-6791

Authorized Official
Title or Position	:	ACCESS MANAGER
Name	:	MRS. GLORIA GONZALEZ
Credential	:
Telephone Number	:	787-879-3828

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	03/05/2026

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