Healthcare Provider Details

I. General information

NPI: 1891298832
Provider Name (Legal Business Name): NIEVES-NIEVES, PULMONARY, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2018
Last Update Date: 03/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10794 PINES BLVD
PEMBROKE PINES FL
33026-3920
US

IV. Provider business mailing address

PO BOX 16357
PLANTATION FL
33318-6357
US

V. Phone/Fax

Practice location:
  • Phone: 954-538-8543
  • Fax:
Mailing address:
  • Phone: 787-365-1018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberME125202
License Number StateFL

VIII. Authorized Official

Name: JOSE J NIEVES
Title or Position: MD
Credential:
Phone: 787-365-1018