Healthcare Provider Details

I. General information

NPI: 1386781466
Provider Name (Legal Business Name): RAQUEL NATALIA NIEVES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATALIE NIEVES-BERNAL

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 E STANLEY BLVD STE 103
LIVERMORE CA
94550-4270
US

IV. Provider business mailing address

1133 E STANLEY BLVD STE 103
LIVERMORE CA
94550-4270
US

V. Phone/Fax

Practice location:
  • Phone: 925-455-5050
  • Fax: 925-455-5084
Mailing address:
  • Phone: 925-455-5050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA09062400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC150185
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: