Provider Demographics
NPI:1669413720
Name:CHEVRES, ITZA DORIS (MD)
Entity type:Individual
Prefix:DR
First Name:ITZA
Middle Name:DORIS
Last Name:CHEVRES
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 1:143 CALLE CEDRO
Mailing Address - Street 2:URB. HACIENDA MI QUERIDO VIEJO
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-2608
Mailing Address - Country:US
Mailing Address - Phone:939-645-0504
Mailing Address - Fax:787-870-7852
Practice Address - Street 1:CALLE 10 CARR.165 ESQ. G-21 URB. VILLA MATILDE
Practice Address - Street 2:
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-0000
Practice Address - Country:US
Practice Address - Phone:787-870-7000
Practice Address - Fax:787-870-6382
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9462208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR81715Medicare ID - Type Unspecified