Provider Demographics
NPI:1235100777
Name:NEVAREZ ALONSO, MARIO R (MD)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:R
Last Name:NEVAREZ ALONSO
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 1:325 BLVD. MEDIA LUNA
Mailing Address - Street 2:COND. BRISAS DE PARQUE ESCORIAL APT. 2904
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-5150
Mailing Address - Country:US
Mailing Address - Phone:787-281-0643
Mailing Address - Fax:
Practice Address - Street 1:252 CALLE SAN JORGE
Practice Address - Street 2:SAN JORGE MEDICAL OFFICE BLDG. SUITE 406
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00912-3310
Practice Address - Country:US
Practice Address - Phone:787-726-0210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10845208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics