Healthcare Provider Details

I. General information

NPI: 1265668719
Provider Name (Legal Business Name): MARIA LIZETTE NIEVES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 07/03/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HOSPITAL GUANTANAMO BAY PSC 1005
FPO AA
34009
US

IV. Provider business mailing address

NAVAL HOSPITAL GUANTANAMO BAY PSC 1005 BOX 110185
FPO AA
34009
US

V. Phone/Fax

Practice location:
  • Phone: 508-505-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1265668719
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: