1104194539 NPI number — MRS. YADERIS ROSA NIEVES CERTIFICADE

Table of content: MRS. YADERIS ROSA NIEVES CERTIFICADE (NPI 1104194539)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104194539 NPI number — MRS. YADERIS ROSA NIEVES CERTIFICADE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIEVES
Provider First Name:
YADERIS
Provider Middle Name:
ROSA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CERTIFICADE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104194539
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HC 3 BOX 36011
Provider Second Line Business Mailing Address:
BO. ACEITUNAS SECTOR OJO CARR 464 KM 3.3 INT
Provider Business Mailing Address City Name:
MOCA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00676-9028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-235-9484
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BO. ACEITUNAS SECTOR OJO CARR464 KM3.3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOCA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00676
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-896-1850
Provider Business Practice Location Address Fax Number:
787-896-8025
Provider Enumeration Date:
12/13/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183700000X , with the licence number:  8698 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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