Basic Information
| Provider Information | |||||||||
| NPI: | 1548304298 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NIEVES VAZQUEZ | ||||||||
| FirstName: | AIDA | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1357 | ||||||||
| Address2: | |||||||||
| City: | CAGUAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007261357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872862800 | ||||||||
| FaxNumber: | 1212862805 | ||||||||
| Practice Location | |||||||||
| Address1: | K3 CALLE ALELI | ||||||||
| Address2: | URB. CARIBE GARDENS | ||||||||
| City: | CAGUAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007253407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7875865254 | ||||||||
| FaxNumber: | 7874743051 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2007 | ||||||||
| LastUpdateDate: | 01/25/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 10163 | PR | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.