Provider Demographics
NPI:1952726903
Name:NIEVES, BLANCA
Entity Type:Individual
Prefix:
First Name:BLANCA
Middle Name:
Last Name:NIEVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 01 BOX 6227
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00676
Mailing Address - Country:UM
Mailing Address - Phone:787-247-0353
Mailing Address - Fax:
Practice Address - Street 1:HC 1 BOX 6227
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-9088
Practice Address - Country:US
Practice Address - Phone:787-247-0353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1779183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2006713OtherLICENSE