Provider Demographics
NPI:1578530853
Name:FREYRE, NILSA IVETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:NILSA
Middle Name:IVETTE
Last Name:FREYRE
Suffix:
Gender:F
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:C15 CALLE TULANE
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-4903
Mailing Address - Country:US
Mailing Address - Phone:787-767-0337
Mailing Address - Fax:
Practice Address - Street 1:268 CALLE SAN JORGE
Practice Address - Street 2:
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00912-3352
Practice Address - Country:US
Practice Address - Phone:787-982-1001
Practice Address - Fax:787-982-1003
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7982174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7982OtherPR STATE LICENSE