Provider Demographics
NPI:1639341878
Name:NIEVES, NOELIA
Entity Type:Individual
Prefix:
First Name:NOELIA
Middle Name:
Last Name:NIEVES
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 1:109 CALLE SAN CARLOS
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-1737
Mailing Address - Country:US
Mailing Address - Phone:787-895-2333
Mailing Address - Fax:787-895-2333
Practice Address - Street 1:109 CALLE SAN CARLOS
Practice Address - Street 2:
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678-1737
Practice Address - Country:US
Practice Address - Phone:787-895-2333
Practice Address - Fax:787-895-2333
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0399291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0030155Medicare PIN