Provider Demographics
NPI:1366487597
Name:NUNEZ FIDALGO, SYLVIA MONSERRATE
Entity Type:Individual
Prefix:DR
First Name:SYLVIA
Middle Name:MONSERRATE
Last Name:NUNEZ FIDALGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. VALPARAISO CALLE 3 J-6
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00940-4040
Mailing Address - Country:US
Mailing Address - Phone:787-315-2879
Mailing Address - Fax:787-261-6530
Practice Address - Street 1:900 CALLE CERRA
Practice Address - Street 2:ESQ CALLE HOARE PDA 15
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-5104
Practice Address - Country:US
Practice Address - Phone:787-977-0520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14729208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR23935Medicare ID - Type UnspecifiedPROVIDER NUMBER