Healthcare Provider Details

I. General information

NPI: 1902016231
Provider Name (Legal Business Name): IVELISSE NIEVES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 AVE ESMERALDA URB MUNOZ RIVERA
GUAYNABO PR
00969-4429
US

IV. Provider business mailing address

26 CARR 833 406-J LA VILLA GARDEN APT.
GUAYNABO PR
00971-9001
US

V. Phone/Fax

Practice location:
  • Phone: 787-720-7439
  • Fax: 787-790-3925
Mailing address:
  • Phone: 787-409-9154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number3289
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: