Provider Demographics
NPI:1275113318
Name:NIEVES, GABRIEL ALFONSO (MD)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:ALFONSO
Last Name:NIEVES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DUMAS LN
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-2431
Mailing Address - Country:US
Mailing Address - Phone:787-637-9428
Mailing Address - Fax:
Practice Address - Street 1:10 DUMAS LN
Practice Address - Street 2:
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054-2431
Practice Address - Country:US
Practice Address - Phone:787-637-9428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program