Provider Demographics
NPI:1659411585
Name:NIEVES, GIL ALBERTO (PH D)
Entity type:Individual
Prefix:MR
First Name:GIL
Middle Name:ALBERTO
Last Name:NIEVES
Suffix:
Gender:M
Credentials:PH D
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 850
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-0850
Mailing Address - Country:US
Mailing Address - Phone:787-409-7197
Mailing Address - Fax:787-863-1422
Practice Address - Street 1:AVE. GENERAL VALERO # 305
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738
Practice Address - Country:US
Practice Address - Phone:787-863-7788
Practice Address - Fax:787-863-1422
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2879183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist