Provider Demographics
NPI:1558003509
Name:NEVAREZ, IVETTE N
Entity Type:Individual
Prefix:
First Name:IVETTE
Middle Name:N
Last Name:NEVAREZ
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:B5 CALLE 15
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-7826
Mailing Address - Country:US
Mailing Address - Phone:787-955-8262
Mailing Address - Fax:
Practice Address - Street 1:35 AV. JUAN CARLOS DE BORBON STE 77
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-287-3725
Practice Address - Fax:787-287-3711
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
06900183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician