Provider Demographics
NPI:1194806919
Name:RODRIGUEZ-NIEVES, EVELYN (DMD)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:RODRIGUEZ-NIEVES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC-04 BOX 43945
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-9441
Mailing Address - Country:US
Mailing Address - Phone:787-819-0167
Mailing Address - Fax:
Practice Address - Street 1:CARR 2 KM 120.2
Practice Address - Street 2:
Practice Address - City:AGUDILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-891-2261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2623122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist