Provider Demographics
NPI:1407854060
Name:SCARANO-GARCIA, JENARO (MD)
Entity Type:Individual
Prefix:DR
First Name:JENARO
Middle Name:
Last Name:SCARANO-GARCIA
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 801058
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-1058
Mailing Address - Country:US
Mailing Address - Phone:787-840-9015
Mailing Address - Fax:787-848-5820
Practice Address - Street 1:8186 CALLE CONCORDIA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1515
Practice Address - Country:US
Practice Address - Phone:787-840-9015
Practice Address - Fax:787-848-5820
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR82412084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7320016OtherHUMANA PROVIDER
PR3102OtherINT MED CARD PROVIDER
PR99647OtherTRIPLE S PROVIDER
PR7320016OtherHUMANA PROVIDER
PR0099647Medicare ID - Type UnspecifiedPROVIDER