Provider Demographics
NPI:1073808994
Name:NIEVES, LAURA CAROLINA (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:CAROLINA
Last Name:NIEVES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1901 TOWN AND COUNTRY DR STE 104
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-3611
Mailing Address - Country:US
Mailing Address - Phone:951-808-6250
Mailing Address - Fax:951-738-9954
Practice Address - Street 1:1820 FULLERTON AVE STE 115
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-3160
Practice Address - Country:US
Practice Address - Phone:951-817-5000
Practice Address - Fax:951-817-5002
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA152521207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine