Provider Demographics
NPI:1215443494
Name:NIEVES, SUMAYYAH
Entity type:Individual
Prefix:
First Name:SUMAYYAH
Middle Name:
Last Name:NIEVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 16TH STREET
Mailing Address - Street 2:1102
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-7374
Mailing Address - Country:US
Mailing Address - Phone:619-777-0902
Mailing Address - Fax:
Practice Address - Street 1:640 16TH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-7374
Practice Address - Country:US
Practice Address - Phone:619-777-0902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-24
Last Update Date:2017-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN95140638163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse