Provider Demographics
NPI:1255352746
Name:NIEVES, CARMEN MARIZOR (MD)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:MARIZOR
Last Name:NIEVES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 CALLE MALLORCA
Mailing Address - Street 2:MANSIONES VISTAMAR MARINA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983-1585
Mailing Address - Country:US
Mailing Address - Phone:787-257-7821
Mailing Address - Fax:787-257-7821
Practice Address - Street 1:10 CALLE CASIA
Practice Address - Street 2:SAN JUAN VAMC
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00921-3200
Practice Address - Country:US
Practice Address - Phone:787-641-7582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11981207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine