1710937891 NPI number — EDGAR A. NEVAREZ-SOSTRE M.D.

Table of content: EDGAR A. NEVAREZ-SOSTRE M.D. (NPI 1710937891)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710937891 NPI number — EDGAR A. NEVAREZ-SOSTRE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEVAREZ-SOSTRE
Provider First Name:
EDGAR
Provider Middle Name:
A.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710937891
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CALLE 9 # B-4 URB. JARDINES DE DORADO
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DORADO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00646
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-240-1809
Provider Business Mailing Address Fax Number:
787-796-7313

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARRETERA #2 KM. 4 HCT. 40
Provider Second Line Business Practice Location Address:
EDIFICIO 4060 SUITE # 6
Provider Business Practice Location Address City Name:
VEGA BAJA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00693
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-240-1809
Provider Business Practice Location Address Fax Number:
787-796-7313
Provider Enumeration Date:
05/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  12124 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6740055 . This is a "PHYSICIAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 990472 . This is a "PHYSICIAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 2-12124 . This is a "PHYSICIAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 5089 . This is a "PHYSICIAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: X0000 . This is a "PHYSICIAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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