Provider Demographics
NPI:1104194539
Name:ROSA NIEVES, YADERIS (CERTIFICADE)
Entity type:Individual
Prefix:MRS
First Name:YADERIS
Middle Name:
Last Name:ROSA NIEVES
Suffix:
Gender:F
Credentials:CERTIFICADE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 3 BOX 36011
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-9028
Mailing Address - Country:US
Mailing Address - Phone:787-363-6577
Mailing Address - Fax:
Practice Address - Street 1:3 URB RAHOLISA GDNS
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-2415
Practice Address - Country:US
Practice Address - Phone:787-896-2080
Practice Address - Fax:787-896-6100
Is Sole Proprietor?:No
Enumeration Date:2011-12-13
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8698183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician