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General NPI Number Information
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NPI Number | 1467010579
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Entity Type | Individual
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Provider Name | ILEANA MARIE NIEVES MARTINEZ
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Gender | Female
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Dates
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Enumeration Date | 06/04/2019
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 1114 AVE JESUS T PINERO
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City | SAN JUAN
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State | PR
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Zip | 00921-1722
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Country | US
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Telephone | 787-781-3020
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Fax |
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Provider Business Mailing Address
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Address Line | 1976 CALLE SALVIA
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City | GUAYNABO
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State | PR
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Zip | 00969-3943
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Country | US
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Telephone | 787-789-6940
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Fax |
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 68067
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207WX0110X
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Taxonomy Name | Pediatric Ophthalmology and Strabismus Specialist Physician Physician
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License Number | 24080
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License Number State | PR
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