Provider Demographics
NPI:1962284117
Name:SANTOS NIEVES, FERNANDO LUIS
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:LUIS
Last Name:SANTOS NIEVES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 75
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-0075
Mailing Address - Country:US
Mailing Address - Phone:787-692-5200
Mailing Address - Fax:
Practice Address - Street 1:997 CALLE SAN ROBERTO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-2759
Practice Address - Country:US
Practice Address - Phone:787-773-6508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL46139390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program