Provider Demographics
NPI:1407941792
Name:NIEVES MARTINEZ, CARLOS RENALDO (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:RENALDO
Last Name:NIEVES MARTINEZ
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:PO BOX 641
Mailing Address - Street 2:
Mailing Address - City:SABANA HOYOS
Mailing Address - State:PR
Mailing Address - Zip Code:00688
Mailing Address - Country:US
Mailing Address - Phone:787-881-4228
Mailing Address - Fax:787-881-4228
Practice Address - Street 1:CARRETERA#2 KM 63.1
Practice Address - Street 2:CANDELARIA
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-881-4228
Practice Address - Fax:787-881-4228
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8882208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC82656Medicare UPIN
PR80038Medicare ID - Type Unspecified