Provider Demographics
NPI:1750415949
Name:NIEVES, WALESKA (MD)
Entity type:Individual
Prefix:DR
First Name:WALESKA
Middle Name:
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:CARR 417 KM 0.0 BO PIEDRAS BLANCAS
Mailing Address - Street 2:P O BOX 1954
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605
Mailing Address - Country:US
Mailing Address - Phone:787-252-0110
Mailing Address - Fax:787-252-0110
Practice Address - Street 1:CARR417 KM 0.0 BO PIEDRAS BLANCAS
Practice Address - Street 2:BOX 1954
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00605
Practice Address - Country:US
Practice Address - Phone:787-252-0110
Practice Address - Fax:787-252-0110
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11590208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics