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General NPI Number Information
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NPI Number | 1922774470
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Entity Type | Individual
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Provider Name | ALISSA J NIEVES
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Gender | Female
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Dates
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Enumeration Date | 08/16/2021
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Last Update Date | 08/21/2021
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Provider Practice Location Address
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Address Line | 3565 W 22ND ST UNIT E
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City | YUMA
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State | AZ
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Zip | 85364-7626
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Country | US
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Telephone | 928-315-3254
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Fax |
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Provider Business Mailing Address
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Address Line | 3818 W 16TH ST
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City | YUMA
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State | AZ
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Zip | 85364-4107
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Country | US
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Telephone | 928-317-0177
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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 | 385HR2055X
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Taxonomy Name | Child Mental Illness Respite Care
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License Number | 11170207
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number | 11170207
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License Number State | AZ
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