MEDICARE: MARIO R. NEVAREZ ALONSO M.D.

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	208000000X	Pediatrics Physician	10845	PR

General Provider Information

NPI Number	:	1235100777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIO R. NEVAREZ ALONSO M.D.

Provider Business Mailing Address
First Line	:	325 BLVD. MEDIA LUNA
Second Line	:	COND. BRISAS DE PARQUE ESCORIAL APT. 2904
City	:	CAROLINA
State	:	PR
Zip	:	00987-5150
Country	:	US
Telephone Number	:	787-281-0643
Fax Number	:

Provider Business Practice Location Address
First Line	:	252 CALLE SAN JORGE
Second Line	:	SAN JORGE MEDICAL OFFICE BLDG. SUITE 406
City	:	SAN JUAN
State	:	PR
Zip	:	00912-3310
Country	:	US
Telephone Number	:	787-726-0210
Fax Number	:

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

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	12/17/2008

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