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General NPI Number Information
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NPI Number | 1891298832
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Entity Type | Organization
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Legal Business Name | NIEVES-NIEVES, PULMONARY, MD, LLC
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Dates
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Enumeration Date | 03/15/2018
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Last Update Date | 03/15/2018
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Provider Practice Location Address
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Address Line | 10794 PINES BLVD
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-3920
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Country | US
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Telephone | 954-538-8543
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 16357
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City | PLANTATION
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State | FL
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Zip | 33318-6357
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Country | US
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Telephone | 787-365-1018
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Fax |
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Authorized Official
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Title or Position | MD
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Name | JOSE J NIEVES
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Credential |
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Telephone | 787-365-1018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | ME125202
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License Number State | FL
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