Provider Demographics
NPI:1992269302
Name:NEFROMD PSC.
Entity type:Organization
Organization Name:NEFROMD PSC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ-MONTALVO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-595-3315
Mailing Address - Street 1:147 CALLE DORADO
Mailing Address - Street 2:URB ESTANCIA DE MANATI
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:787-595-3315
Mailing Address - Fax:
Practice Address - Street 1:COROZAL SHOPPING CENTER
Practice Address - Street 2:CARR 159 KM 23.7 BO DOS BOCAS SECTOR LOMA LINDA
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783
Practice Address - Country:US
Practice Address - Phone:787-595-3315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty