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General NPI Number Information
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NPI Number | 1265570345
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Entity Type | Individual
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Provider Name | WANDA I NIEVES M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 08/24/2018
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Provider Practice Location Address
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Address Line | CALLEJONES HC01-4195
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City | LARES
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State | PR
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Zip | 00669
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Country | US
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Telephone | 787-315-4824
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Fax | 787-650-8800
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Provider Business Mailing Address
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Address Line | CALLEJONES HC01-4195
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City | LARES
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State | PR
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Zip | 00669-4195
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Country | US
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Telephone | 787-315-4824
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Fax | 787-650-8800
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 146D00000X
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Taxonomy Name | Personal Emergency Response Attendant
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License Number | 16597
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 016597
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License Number State | PR
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