Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 655 | PR |
NPI | 1003390261 |
---|---|
Provider Name | Dr. Jose Rafael Nieves-Lopez |
First Address | Mayaguez, PR 00680-6215 |
Second Address | Anasco, PR 00610 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2018 |
Last Update Date | 11/01/2022 |