Provider Demographics
NPI:1669528444
Name:SEVERINO, NORMA SORAYA (MD)
Entity type:Individual
Prefix:DR
First Name:NORMA
Middle Name:SORAYA
Last Name:SEVERINO
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 1:1631 CALLE NIEPER
Mailing Address - Street 2:URB. EL CEREZAL
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-3133
Mailing Address - Country:US
Mailing Address - Phone:787-599-1058
Mailing Address - Fax:787-764-9314
Practice Address - Street 1:CARRETERA 186 KM 7.5
Practice Address - Street 2:
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729
Practice Address - Country:US
Practice Address - Phone:787-256-2266
Practice Address - Fax:787-764-9314
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR15796208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0023093Medicare ID - Type Unspecified
PRI30244Medicare UPIN