Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 216220 | MA |
NPI | 1003848037 |
---|---|
Provider Name | Omayra Nieves |
First Address | Somerville, MA 02143-4370 |
Second Address | Somerville, MA 02143-4370 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 08/07/2007 |