Provider Demographics
NPI:1497857239
Name:HUMARAN, NESTOR I (MD)
Entity Type:Individual
Prefix:
First Name:NESTOR
Middle Name:I
Last Name:HUMARAN
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 1:14255 SABAL DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014
Mailing Address - Country:US
Mailing Address - Phone:305-823-1836
Mailing Address - Fax:305-556-2449
Practice Address - Street 1:1255 WEST 46 ST
Practice Address - Street 2:SUITE #9
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012
Practice Address - Country:US
Practice Address - Phone:305-823-1836
Practice Address - Fax:305-556-2449
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0040086208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
95951Medicare ID - Type Unspecified
D27929Medicare UPIN