Healthcare Provider Details

I. General information

NPI: 1861751554
Provider Name (Legal Business Name): DR HECTOR D NIEVES VAZQUEZ PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2012
Last Update Date: 05/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PANORAMA VILLAGE VISTA DEL MAR 198
BAYAMON PR
00957
US

IV. Provider business mailing address

PO BOX 478
BAYAMON PR
00960-0478
US

V. Phone/Fax

Practice location:
  • Phone: 787-728-5101
  • Fax:
Mailing address:
  • Phone: 787-728-5101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number8211
License Number StatePR

VIII. Authorized Official

Name: DR. HECTOR DAVID NIEVES
Title or Position: PEDIATRA
Credential: M.D.
Phone: 787-728-5101