Provider Demographics
NPI:1245498021
Name:STUART, NELSON
Entity type:Individual
Prefix:MR
First Name:NELSON
Middle Name:
Last Name:STUART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 CALLE PALMER
Mailing Address - Street 2:
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-2453
Mailing Address - Country:US
Mailing Address - Phone:787-870-2467
Mailing Address - Fax:939-337-1771
Practice Address - Street 1:58 CALLE PALMER
Practice Address - Street 2:
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-2453
Practice Address - Country:US
Practice Address - Phone:787-870-2467
Practice Address - Fax:787-870-0376
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1618291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR30977OtherMEDICARE PROVIDER
PR30977OtherMEDICARE PROVIDER