Provider Demographics
NPI:1750442497
Name:NIEVES PEREZ, VIANNY (MD)
Entity Type:Individual
Prefix:DR
First Name:VIANNY
Middle Name:
Last Name:NIEVES PEREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VIANNY
Other - Middle Name:
Other - Last Name:NIEVES PEREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:ALTURAS DE SAN LORENZO
Mailing Address - Street 2:CALLE 5B NUM G47
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754
Mailing Address - Country:US
Mailing Address - Phone:787-715-3620
Mailing Address - Fax:787-737-0244
Practice Address - Street 1:150 CALLE TOUS SOTO S
Practice Address - Street 2:SUITE #2
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754-3923
Practice Address - Country:US
Practice Address - Phone:787-937-7700
Practice Address - Fax:787-937-7700
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15199208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR23157Medicare ID - Type Unspecified