Provider Demographics
NPI:1902023708
Name:NIEVES, ISELA (OD)
Entity Type:Individual
Prefix:DR
First Name:ISELA
Middle Name:
Last Name:NIEVES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LL16 CALLE PLAYA
Mailing Address - Street 2:DORADO DEL MAR
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-2321
Mailing Address - Country:US
Mailing Address - Phone:787-278-1706
Mailing Address - Fax:
Practice Address - Street 1:AVE COMERIO # CC-33
Practice Address - Street 2:RIO HONDO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-4477
Practice Address - Country:US
Practice Address - Phone:787-269-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR418152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist