Provider Demographics
NPI:1205008901
Name:GONZALEZ NIEVES, WALESKA (MD)
Entity Type:Individual
Prefix:DR
First Name:WALESKA
Middle Name:
Last Name:GONZALEZ NIEVES
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:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-0009
Mailing Address - Country:US
Mailing Address - Phone:787-647-0478
Mailing Address - Fax:
Practice Address - Street 1:CALLE 111 KM 1.9
Practice Address - Street 2:LOS PATRIOTAS AVE
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669
Practice Address - Country:US
Practice Address - Phone:787-647-0478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17071208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1205008901OtherHY682A, PTAN