Provider Demographics
NPI:1255546511
Name:NIEVES, ANA GEORGINA (PH)
Entity type:Individual
Prefix:MRS
First Name:ANA
Middle Name:GEORGINA
Last Name:NIEVES
Suffix:
Gender:F
Credentials:PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 04 BOX 8302
Mailing Address - Street 2:
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-9723
Mailing Address - Country:US
Mailing Address - Phone:787-876-2006
Mailing Address - Fax:787-256-0306
Practice Address - Street 1:CARR. 185 KM 15.8
Practice Address - Street 2:LAS CUATROCIENTAS
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-9723
Practice Address - Country:US
Practice Address - Phone:787-876-2006
Practice Address - Fax:787-256-0306
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2373183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist