Healthcare Provider Details

I. General information

NPI: 1083894315
Provider Name (Legal Business Name): DELMA JULIETA NIEVES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2007
Last Update Date: 03/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 S MAIN ST
ORANGE CA
92868-3874
US

IV. Provider business mailing address

455 S MAIN ST PSF CREDENTIALING
ORANGE CA
92868-3874
US

V. Phone/Fax

Practice location:
  • Phone: 714-532-8403
  • Fax: 714-289-4014
Mailing address:
  • Phone: 714-289-4511
  • Fax: 714-204-3212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA87032
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberA87032
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: