Provider Demographics
NPI:1841407483
Name:NIEVES, MYRNA R (MD)
Entity Type:Individual
Prefix:DR
First Name:MYRNA
Middle Name:R
Last Name:NIEVES
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3013 AVE ALEJANDRINO
Mailing Address - Street 2:FONTAINEBLEU PLAZA PH-2501
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-7038
Mailing Address - Country:US
Mailing Address - Phone:787-720-2324
Mailing Address - Fax:787-720-2324
Practice Address - Street 1:3013 AVE ALEJANDRINO
Practice Address - Street 2:FONTAINEBLEU PLAZA PH-2501
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-7038
Practice Address - Country:US
Practice Address - Phone:787-720-2324
Practice Address - Fax:787-720-2324
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR9050208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics