Provider Demographics
NPI:1376747766
Name:NIEVES-RODRIGUEZ, MARIELA (MD)
Entity type:Individual
Prefix:DR
First Name:MARIELA
Middle Name:
Last Name:NIEVES-RODRIGUEZ
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:URB. SABANERA DORADO
Mailing Address - Street 2:#348 CAMINO DEL CUPEY
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-349-2835
Mailing Address - Fax:
Practice Address - Street 1:77 CALLE SANTA CRUZ
Practice Address - Street 2:URB. SANTA CRUZ
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-6935
Practice Address - Country:US
Practice Address - Phone:787-300-2815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17901207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism