Provider Demographics
NPI:1225014061
Name:NIEVES GARNICA, PEDRO LUIS I (MD)
Entity type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:LUIS
Last Name:NIEVES GARNICA
Suffix:I
Gender:M
Credentials:MD
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Mailing Address - Street 1:DELCASSE 20, APT. 1103
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1698
Mailing Address - Country:US
Mailing Address - Phone:787-767-4853
Mailing Address - Fax:787-767-4853
Practice Address - Street 1:334 OFICINA 1 AVE. AMERICO MIRANDA
Practice Address - Street 2:URB VILLA NEVAREZ
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927-4721
Practice Address - Country:US
Practice Address - Phone:787-767-4853
Practice Address - Fax:787-767-4853
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR8116207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF47557Medicare UPIN
PR82826Medicare ID - Type Unspecified