Provider Demographics
NPI:1659617967
Name:NICOLAU, YANIA (MD)
Entity Type:Individual
Prefix:DR
First Name:YANIA
Middle Name:
Last Name:NICOLAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 CARR 177
Mailing Address - Street 2:APT 606
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5348
Mailing Address - Country:US
Mailing Address - Phone:787-367-5057
Mailing Address - Fax:
Practice Address - Street 1:139 CARR 177
Practice Address - Street 2:APT 606
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-5348
Practice Address - Country:US
Practice Address - Phone:787-367-5057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-14
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18978208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty