Healthcare Provider Details

I. General information

NPI: 1710956909
Provider Name (Legal Business Name): NERIS MILAGROS NIEVES-ROBBINS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 03/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN US ARMY MEDICAL CENTER RADIOLOGY MCHJ-DR BLDG 9040 FITZSIMMONS DRIVE FORT LEWIS
TACOMA WA
98431-0001
US

IV. Provider business mailing address

11408 HUGGINS MEYER RD SW
LAKEWOOD WA
98498-3617
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-2130
  • Fax:
Mailing address:
  • Phone: 253-968-2130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number35081316
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: