MEDICARE: DR. NILSA IVETTE FREYRE 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	174400000X	Specialist	7982	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7982	OTHER	PR	PR STATE LICENSE

General Provider Information

NPI Number	:	1578530853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NILSA IVETTE FREYRE M.D.

Provider Business Mailing Address
First Line	:	C15 CALLE TULANE
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00927-4903
Country	:	US
Telephone Number	:	787-767-0337
Fax Number	:

Provider Business Practice Location Address
First Line	:	268 CALLE SAN JORGE
Second Line	:
City	:	SANTURCE
State	:	PR
Zip	:	00912-3352
Country	:	US
Telephone Number	:	787-982-1001
Fax Number	:	787-982-1003

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

Provider Enumeration Date	:	03/04/2006
Last Update Date	:	07/08/2007

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