Provider Demographics
NPI:1497409643
Name:MARCIAL NIEVES, GENARO ANTONIO (MD)
Entity type:Individual
Prefix:DR
First Name:GENARO
Middle Name:ANTONIO
Last Name:MARCIAL NIEVES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 250579
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00604-0579
Mailing Address - Country:US
Mailing Address - Phone:787-223-7924
Mailing Address - Fax:
Practice Address - Street 1:8890 W OAKLAND PARK BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7223
Practice Address - Country:US
Practice Address - Phone:954-741-3304
Practice Address - Fax:754-222-6417
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR24082208D00000X
PR1794363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice