Provider Demographics
NPI:1164597233
Name:NIEVES-LAYES, DARTAGNAN
Entity Type:Individual
Prefix:
First Name:DARTAGNAN
Middle Name:
Last Name:NIEVES-LAYES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:LABORATORIO CLINICO
Other - Middle Name:
Other - Last Name:NIEVES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1736
Mailing Address - Street 2:
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00694-1736
Mailing Address - Country:US
Mailing Address - Phone:787-855-1811
Mailing Address - Fax:787-855-1811
Practice Address - Street 1:URB BRASILIA CALLE 3 E7
Practice Address - Street 2:
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-855-1811
Practice Address - Fax:787-855-1811
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR927291U00000X
PR2266246QL0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QL0900XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyLaboratory Management
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0031168OtherMEDICARE