Provider Demographics
NPI:1265570345
Name:NIEVES, WANDA I (MD)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:I
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:CALLEJONES
Mailing Address - Street 2:HC01-4195
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-4195
Mailing Address - Country:US
Mailing Address - Phone:787-315-4824
Mailing Address - Fax:787-650-8800
Practice Address - Street 1:CALLEJONES
Practice Address - Street 2:HC01-4195
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669
Practice Address - Country:US
Practice Address - Phone:787-315-4824
Practice Address - Fax:787-650-8800
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR16597146D00000X
PR016597208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant