Provider Demographics
NPI:1508901612
Name:NIEVES, MILY (MD)
Entity Type:Individual
Prefix:DR
First Name:MILY
Middle Name:
Last Name:NIEVES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VIRGEN
Other - Middle Name:MILAGROS
Other - Last Name:NIEVES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 6730
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-6730
Mailing Address - Country:US
Mailing Address - Phone:480-821-3600
Mailing Address - Fax:480-821-3610
Practice Address - Street 1:1142 E SOUTHERN AVE STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5056
Practice Address - Country:US
Practice Address - Phone:480-821-3600
Practice Address - Fax:480-857-2667
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36917207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
9010093OtherABOG BOARD CERTIFIED
AZ222419Medicaid
AZFN0201866OtherDEA
AZ222419Medicaid