Provider Demographics
NPI:1043206246
Name:FRONTERA-TACORONTE, NESTOR R (MD)
Entity Type:Individual
Prefix:DR
First Name:NESTOR
Middle Name:R
Last Name:FRONTERA-TACORONTE
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 1:3201 PORTALES DEL MONTE
Mailing Address - Street 2:COTTO LAUREL
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00780-2033
Mailing Address - Country:US
Mailing Address - Phone:787-410-1144
Mailing Address - Fax:787-821-5828
Practice Address - Street 1:44 CALLE 25 DE JULIO
Practice Address - Street 2:
Practice Address - City:GUANICA
Practice Address - State:PR
Practice Address - Zip Code:00653-2712
Practice Address - Country:US
Practice Address - Phone:787-821-5828
Practice Address - Fax:787-821-5828
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14482208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI11259Medicare UPIN
21272Medicare ID - Type Unspecified