Provider Demographics
NPI:1427196385
Name:NAZARIO LARRIEU, JAVIER ANDRES (MD)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:ANDRES
Last Name:NAZARIO LARRIEU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAVIER
Other - Middle Name:ANDRES
Other - Last Name:NAZARIO-LARRIEU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 270236
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00928-3036
Mailing Address - Country:US
Mailing Address - Phone:787-308-0449
Mailing Address - Fax:
Practice Address - Street 1:EDIF ARTURO CADILLA 403
Practice Address - Street 2:PASEO SAN PABLO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-308-0449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR177522085R0202X, 2085R0204X
TXM58502085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRDU072ZOtherPTAN