Provider Demographics
NPI:1801050711
Name:NEVARES, CARMEN MILAGROS (MD)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:MILAGROS
Last Name:NEVARES
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:AVE PONCE DE LEON # 1717
Mailing Address - Street 2:2208 PLAZA INMACULADA 2
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-3380
Mailing Address - Country:US
Mailing Address - Phone:787-587-8491
Mailing Address - Fax:787-268-3704
Practice Address - Street 1:AVE PONCE DE LEON # 1717
Practice Address - Street 2:2208 PLAZA INMACULADA 2
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-3380
Practice Address - Country:US
Practice Address - Phone:787-587-8491
Practice Address - Fax:787-268-3704
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2909261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care