Healthcare Provider Details

I. General information

NPI: 1164597233
Provider Name (Legal Business Name): DARTAGNAN NIEVES-LAYES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: LABORATORIO CLINICO NIEVES

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB BRASILIA CALLE 3 E7
VEGA BAJA PR
00693
US

IV. Provider business mailing address

PO BOX 1736
VEGA BAJA PR
00694-1736
US

V. Phone/Fax

Practice location:
  • Phone: 787-855-1811
  • Fax: 787-855-1811
Mailing address:
  • Phone: 787-855-1811
  • Fax: 787-855-1811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number927
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code246QL0900X
TaxonomyLaboratory Management Specialist/Technologist
License Number2266
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: