Provider Demographics
NPI:1215715008
Name:NIEVES ORTIZ, ROBERT (CRNA)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:NIEVES ORTIZ
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB GOLDEN GATE 2
Mailing Address - Street 2:ST. I M4
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-1152
Mailing Address - Country:US
Mailing Address - Phone:787-533-6826
Mailing Address - Fax:
Practice Address - Street 1:URB GOLDEN GATE 2
Practice Address - Street 2:ST. I M4
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-1152
Practice Address - Country:US
Practice Address - Phone:787-533-6826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR145364367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered