Provider Demographics
NPI:1770632572
Name:NIEVES, CARLOS MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:MANUEL
Last Name:NIEVES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2000 CARR 8177
Mailing Address - Street 2:STE 26, PMB 522
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-3762
Mailing Address - Country:US
Mailing Address - Phone:787-786-6792
Mailing Address - Fax:787-798-5253
Practice Address - Street 1:100 PASEO SAN PABLO
Practice Address - Street 2:EDIF. DR. ARTURO CADILLA SUITE 202
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7019
Practice Address - Country:US
Practice Address - Phone:787-786-6792
Practice Address - Fax:787-798-5253
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR10855207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF34389Medicare UPIN
PR8-3002Medicare ID - Type Unspecified