Provider Demographics
NPI:1265476980
Name:NAZARIO, JUAN ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:ANTONIO
Last Name:NAZARIO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:467 CALLE GAVIOTA
Mailing Address - Street 2:URB. CAMINO DEL SUR
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-2840
Mailing Address - Country:US
Mailing Address - Phone:787-812-3030
Mailing Address - Fax:787-651-4321
Practice Address - Street 1:PONCE VA OUTPATIENT CLINIC
Practice Address - Street 2:1010 PASEO DEL VETERANO
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716
Practice Address - Country:US
Practice Address - Phone:787-812-3030
Practice Address - Fax:787-651-4321
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
PR7764207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine