Provider Demographics
NPI:1932188703
Name:NIEVES MUNIZ, MARIA ELENA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ELENA
Last Name:NIEVES MUNIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DBA LABORATORIO
Other - Middle Name:CLINICO
Other - Last Name:Y BACTERIOLOGICO EBENEZER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3538
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-3538
Mailing Address - Country:US
Mailing Address - Phone:787-882-1785
Mailing Address - Fax:787-658-7155
Practice Address - Street 1:CARR NO 2 KM 118.5 BO CEIBA BAJA
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-882-1785
Practice Address - Fax:787-882-1785
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1003291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR30132Medicare PIN