Provider Demographics
NPI:1437694775
Name:NIEVES, ELIZABETH MARITZA (RD LD/N)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARITZA
Last Name:NIEVES
Suffix:
Gender:F
Credentials:RD LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 SW 93RD PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-3017
Mailing Address - Country:US
Mailing Address - Phone:305-992-1383
Mailing Address - Fax:
Practice Address - Street 1:3100 WESTON RD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3602
Practice Address - Country:US
Practice Address - Phone:954-689-5887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 7057133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered