Provider Demographics
NPI:1093243925
Name:AVILA-NIEVES, RAQUEL
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:
Last Name:AVILA-NIEVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2631 ARLINGTON DR APT B1
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3605
Mailing Address - Country:US
Mailing Address - Phone:787-360-3448
Mailing Address - Fax:
Practice Address - Street 1:9801 GEORGIA AVE
Practice Address - Street 2:SUITE 229
Practice Address - City:SILVER SPRING
Practice Address - State:MARYLAND
Practice Address - Zip Code:20902
Practice Address - Country:UM
Practice Address - Phone:787-376-7819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-23
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004010235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist