Provider Demographics
NPI:1033112529
Name:PORRATA NIEVA, ALEJANDRO A (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEJANDRO
Middle Name:A
Last Name:PORRATA NIEVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16698
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00908-6698
Mailing Address - Country:US
Mailing Address - Phone:787-420-9259
Mailing Address - Fax:
Practice Address - Street 1:29 CALLE WASHINGTON
Practice Address - Street 2:STE. 303
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1510
Practice Address - Country:US
Practice Address - Phone:787-721-2250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15828208VP0014X
FLME87063208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
81722XMedicare UPIN
FL81722Medicare ID - Type Unspecified
FLI04148Medicare UPIN