Provider Demographics
NPI:1972565810
Name:NIEVES, MARTHA IRIS (MD)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:IRIS
Last Name:NIEVES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:HC 02 BOX 13741
Mailing Address - Street 2:BO DOMINGUITO
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-9300
Mailing Address - Country:US
Mailing Address - Phone:787-878-7837
Mailing Address - Fax:787-878-7837
Practice Address - Street 1:CARRETERA 635 KM 01
Practice Address - Street 2:SECTOR GREEN BO DOMINGUITO
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-9300
Practice Address - Country:US
Practice Address - Phone:787-878-7837
Practice Address - Fax:787-878-7837
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14022208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR20798Medicare ID - Type Unspecified
H55690Medicare UPIN