Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | C50175 | PR |
NPI | 1184165680 |
---|---|
Provider Name | Mr. Pablo Enrique Nieves Conde |
First Address | Bayamon, PR 00957-4427 |
Second Address | Bayamon, PR 00957-4427 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2017 |
Last Update Date | 16/03/2017 |