Provider Demographics
NPI:1790394286
Name:NIEVES-BURGOS, GRETCHEN LORRAINE
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:LORRAINE
Last Name:NIEVES-BURGOS
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:PO BOX 1859
Mailing Address - Street 2:
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767-1859
Mailing Address - Country:US
Mailing Address - Phone:787-217-8194
Mailing Address - Fax:
Practice Address - Street 1:BO JUAN MARTIN CARR 901 KM1
Practice Address - Street 2:
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767
Practice Address - Country:US
Practice Address - Phone:787-217-8194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program