Basic Information
| Provider Information | |||||||||
| NPI: | 1235100777 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | NEVAREZ ALONSO | ||||||||
| FirstName: | MARIO | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 325 BLVD. MEDIA LUNA | ||||||||
| Address2: | COND. BRISAS DE PARQUE ESCORIAL APT. 2904 | ||||||||
| City: | CAROLINA | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009875150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872810643 | ||||||||
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| Practice Location | |||||||||
| Address1: | 252 CALLE SAN JORGE | ||||||||
| Address2: | SAN JORGE MEDICAL OFFICE BLDG. SUITE 406 | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009123310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877260210 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2006 | ||||||||
| LastUpdateDate: | 12/17/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 10845 | PR | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.