Provider Demographics
NPI:1386781466
Name:NIEVES, RAQUEL NATALIA (MD)
Entity type:Individual
Prefix:DR
First Name:RAQUEL
Middle Name:NATALIA
Last Name:NIEVES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:
Other - Last Name:NIEVES-BERNAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1133 E STANLEY BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-4270
Mailing Address - Country:US
Mailing Address - Phone:925-455-5050
Mailing Address - Fax:
Practice Address - Street 1:1133 E STANLEY BLVD STE 103
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4270
Practice Address - Country:US
Practice Address - Phone:925-455-5050
Practice Address - Fax:925-455-5084
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09062400208000000X
CAC150185208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics