Provider Demographics
NPI:1366600686
Name:NIEVES, MARIA ANGELICA (PHARMACY TECHNICIAN)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ANGELICA
Last Name:NIEVES
Suffix:
Gender:F
Credentials:PHARMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 CALLE A
Mailing Address - Street 2:BDA CARMEN
Mailing Address - City:SALINAS
Mailing Address - State:PR
Mailing Address - Zip Code:00751-2901
Mailing Address - Country:US
Mailing Address - Phone:787-824-4367
Mailing Address - Fax:
Practice Address - Street 1:AVENUE VETERANOS
Practice Address - Street 2:KM 134-7
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-686-9409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6902183700000X, 247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6902Medicaid
PR6902OtherSTATE LICENSE