Provider Demographics
NPI:1629666714
Name:NIEVES-MARQUEZ, MAYRA NATALIA
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:NATALIA
Last Name:NIEVES-MARQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10402 MANDERLEY WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32829-7359
Mailing Address - Country:US
Mailing Address - Phone:407-982-6881
Mailing Address - Fax:
Practice Address - Street 1:3501 W VINE ST STE 278
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4673
Practice Address - Country:US
Practice Address - Phone:407-818-7201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator