Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 7764 | PR |
NPI | 1265476980 |
---|---|
Provider Name | Dr. Juan Antonio Nazario |
First Address | Ponce, PR 00716-2840 |
Second Address | Ponce, PR 00716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 08/07/2007 |