MEDICARE: DR. FERNANDO GERENA NIEVES M.D ,D.A.B.A ,F.ABPM

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	12238	CT
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	12238	PR

General Provider Information

NPI Number	:	1548245939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FERNANDO GERENA NIEVES M.D ,D.A.B.A ,F.ABPM

Provider Business Mailing Address
First Line	:	PO BOX 2793
Second Line	:
City	:	GUAYNABO
State	:	PR
Zip	:	00970-2793
Country	:	US
Telephone Number	:	787-641-9871
Fax Number	:	787-641-9874

Provider Business Practice Location Address
First Line	:	65 CALLE LOS MANGOS
Second Line	:	CENTRO INT .DE MERCADEO 1 SUITE 301
City	:	CATANO
State	:	PR
Zip	:	00962-5830
Country	:	US
Telephone Number	:	787-641-9871
Fax Number	:	787-641-9874

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

Provider Enumeration Date	:	12/08/2005
Last Update Date	:	11/01/2018

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