Healthcare Provider Details

I. General information

NPI: 1073025300
Provider Name (Legal Business Name): MIRELYS NIEVES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2017
Last Update Date: 10/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 635 KM 2.4 BO DOMINGUITO
ARECIBO PR
00613
US

IV. Provider business mailing address

PO BOX 9211
ARECIBO PR
00613-9211
US

V. Phone/Fax

Practice location:
  • Phone: 787-878-5325
  • Fax:
Mailing address:
  • Phone: 787-878-5324
  • Fax: 787-878-5324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: