Provider Demographics
NPI:1205622727
Name:NAZARIO BRACERO, JOSE M.
Entity type:Individual
Prefix:
First Name:JOSE M.
Middle Name:
Last Name:NAZARIO BRACERO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 CALLE IDILIO
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-4583
Mailing Address - Country:US
Mailing Address - Phone:939-865-8597
Mailing Address - Fax:
Practice Address - Street 1:1400 CALLE IDILIO
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4583
Practice Address - Country:US
Practice Address - Phone:939-865-8597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR014967183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1888303OtherNCPDP (NABP)