Basic Information
| Provider Information | |||||||||
| NPI: | 1245450584 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEVARES | ||||||||
| FirstName: | MAYRA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 STREET # 1059 | ||||||||
| Address2: | VILLA NEVAREZ | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009270000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877647402 | ||||||||
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| Practice Location | |||||||||
| Address1: | UNIVERSITY OF PUERTO RICO MEDICAL SCIENCES CAMPUS | ||||||||
| Address2: | DEPARTMENT OF PSYQUATRY 9TH FLOOR | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009365067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877773535 | ||||||||
| FaxNumber: | 7877647004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 1818 | PR | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.