Healthcare Provider Details

I. General information

NPI: 1548524374
Provider Name (Legal Business Name): MS. NILSA E NORIEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 11/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 NW 14TH ST FL 12
MIAMI FL
33136-2107
US

IV. Provider business mailing address

1120 NW 14TH ST FL 12
MIAMI FL
33136-2107
US

V. Phone/Fax

Practice location:
  • Phone: 347-691-5523
  • Fax: 305-243-3501
Mailing address:
  • Phone: 347-691-5523
  • Fax: 305-243-3501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: