Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 2155 | PR |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 2155 | PR |
N | 2081S0010X | Sports Medicine | 2155 | PR |
N | 213ES0000X | Sports Medicine | 2155 | PR |
NPI | 1528052602 |
---|---|
Provider Name | Nestor V. Cardona Aviles |
First Address | San Juan, PR 00917-3403 |
Second Address | San Juan, PR 00917-3403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2005 |
Last Update Date | 23/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C77924 | (02) | PR |