Provider Demographics
NPI:1275751596
Name:NIEVES, JOSE L
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:L
Last Name:NIEVES
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:URB CIUDAD CENTRAL LL
Mailing Address - Street 2:CALLE RAMON NEGRON 405
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00986
Mailing Address - Country:US
Mailing Address - Phone:787-642-7333
Mailing Address - Fax:
Practice Address - Street 1:1324 CALLE CANADA
Practice Address - Street 2:DE DIEGO AVE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-3860
Practice Address - Country:US
Practice Address - Phone:787-793-1550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR30662164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse