Provider Demographics
NPI:1144230269
Name:NIDO NYLUND, ROQUE A (MD)
Entity type:Individual
Prefix:DR
First Name:ROQUE
Middle Name:A
Last Name:NIDO NYLUND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 180
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-0180
Mailing Address - Country:US
Mailing Address - Phone:787-974-1317
Mailing Address - Fax:787-866-2125
Practice Address - Street 1:AVE. LOS VETERANOS #3
Practice Address - Street 2:GUAYAMA MEDICAL CENTER
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-864-1012
Practice Address - Fax:787-866-2125
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16095207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine