Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor | 681 | PR |
NPI | 1063076792 |
---|---|
Provider Name | Mrs. Lisette Nieves |
First Address | Fajardo, PR 00738 |
Second Address | Las Piedras, PR 00771 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2019 |
Last Update Date | 29/04/2019 |