Provider Demographics
NPI:1265664932
Name:NIEVES, JESSENIA
Entity Type:Individual
Prefix:
First Name:JESSENIA
Middle Name:
Last Name: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:BO. SMIDERO S/ SANTA CLARA CARR 172 KM 6.2
Mailing Address - Street 2:H-C 04 BOX
Mailing Address - City:AGUAS BUENAS
Mailing Address - State:PR
Mailing Address - Zip Code:00703
Mailing Address - Country:US
Mailing Address - Phone:787-553-9685
Mailing Address - Fax:
Practice Address - Street 1:C/173 KM6.2 AGUAS BUENAS
Practice Address - Street 2:H-C 04 BOX 8302
Practice Address - City:AGUAS BUENAS
Practice Address - State:PR
Practice Address - Zip Code:00703
Practice Address - Country:US
Practice Address - Phone:787-739-6600
Practice Address - Fax:787-714-0410
Is Sole Proprietor?:No
Enumeration Date:2009-08-14
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6523183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician