Provider Demographics
NPI:1225065899
Name:NIEVES ALICEA, RAFAEL A
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:A
Last Name:NIEVES ALICEA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CALLE ARAGON # 3 TERRALINDA
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-2505
Mailing Address - Country:US
Mailing Address - Phone:787-743-9261
Mailing Address - Fax:
Practice Address - Street 1:CALLE #3 ARAGON TERRALINDA
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727-2505
Practice Address - Country:US
Practice Address - Phone:787-743-9261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6154207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine