Provider Demographics
NPI:1083678932
Name:NIEVERA, HAYDEE TE (MD)
Entity Type:Individual
Prefix:
First Name:HAYDEE
Middle Name:TE
Last Name:NIEVERA
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 1:1201 CALLE MILAGROS
Mailing Address - Street 2:STE. A
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-1361
Mailing Address - Country:US
Mailing Address - Phone:956-544-4700
Mailing Address - Fax:956-544-4774
Practice Address - Street 1:1201 CALLE MILAGROS
Practice Address - Street 2:STE A
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-1193
Practice Address - Country:US
Practice Address - Phone:956-544-4700
Practice Address - Fax:956-544-4774
Is Sole Proprietor?:No
Enumeration Date:2006-04-15
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0881208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142275002Medicaid