Provider Demographics
NPI:1700839297
Name:ALDIVA, NELSON JOSE
Entity Type:Individual
Prefix:MR
First Name:NELSON
Middle Name:JOSE
Last Name:ALDIVA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 5 BOX 25903
Mailing Address - Street 2:ABRA HONDA CARR 4488 KM 1.0
Mailing Address - City:CAMUY
Mailing Address - State:PR
Mailing Address - Zip Code:00627-9847
Mailing Address - Country:US
Mailing Address - Phone:787-898-5573
Mailing Address - Fax:787-820-5592
Practice Address - Street 1:HC 5 BOX 25903
Practice Address - Street 2:BO. PUENTE ZARZA CARR # 2 KM.90 CALLE INTERIOR
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627-9847
Practice Address - Country:US
Practice Address - Phone:787-820-5592
Practice Address - Fax:787-820-5592
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16149208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice