Provider Demographics
NPI:1043105927
Name:NIEVES, JHONNY ENRIQUE SR
Entity type:Individual
Prefix:MR
First Name:JHONNY
Middle Name:ENRIQUE
Last Name:NIEVES
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3528 SWEETWATER WAY
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-2030
Mailing Address - Country:US
Mailing Address - Phone:619-776-2524
Mailing Address - Fax:
Practice Address - Street 1:3528 SWEETWATER WAY
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-2030
Practice Address - Country:US
Practice Address - Phone:619-776-2524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)