Provider Demographics
NPI:1770549479
Name:NEVARES, RAMON VICENTE (MD)
Entity type:Individual
Prefix:MR
First Name:RAMON
Middle Name:VICENTE
Last Name:NEVARES
Suffix:
Gender:M
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:PO BOX 363489
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-3489
Mailing Address - Country:US
Mailing Address - Phone:787-203-1594
Mailing Address - Fax:787-782-8656
Practice Address - Street 1:CALLE ACAPULCO #1004
Practice Address - Street 2:PUERTO NUEVO
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920
Practice Address - Country:US
Practice Address - Phone:787-203-1594
Practice Address - Fax:787-782-8656
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR67982084P0800X
MA514122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR90130Medicare ID - Type Unspecified