Provider Demographics
NPI:1265405567
Name:NIEVES-TORRES, JOSE A SR (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:NIEVES-TORRES
Suffix:SR
Gender:M
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:PO BOX 2333
Mailing Address - Street 2:DR BASORA ST 55 N
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-2333
Mailing Address - Country:US
Mailing Address - Phone:787-834-0086
Mailing Address - Fax:787-834-0086
Practice Address - Street 1:55 CALLE DR BASORA N
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4810
Practice Address - Country:US
Practice Address - Phone:787-834-0086
Practice Address - Fax:787-834-0086
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6411208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0026970Medicare ID - Type Unspecified
C79602Medicare UPIN