Provider Demographics
NPI:1548245939
Name:GERENA NIEVES, FERNANDO (MD ,DABA ,FABPM)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:
Last Name:GERENA NIEVES
Suffix:
Gender:M
Credentials:MD ,DABA ,FABPM
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 2793
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-2793
Mailing Address - Country:US
Mailing Address - Phone:787-641-9871
Mailing Address - Fax:787-641-9874
Practice Address - Street 1:65 CALLE LOS MANGOS
Practice Address - Street 2:CENTRO INT .DE MERCADEO 1 SUITE 301
Practice Address - City:CATANO
Practice Address - State:PR
Practice Address - Zip Code:00962-5830
Practice Address - Country:US
Practice Address - Phone:787-641-9871
Practice Address - Fax:787-641-9874
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12238207LP2900X
PR12238207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0089263Medicare ID - Type Unspecified