Provider Demographics
NPI:1528841418
Name:NIEVA, DOMINICO A
Entity type:Individual
Prefix:
First Name:DOMINICO
Middle Name:A
Last Name:NIEVA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5611 WINDSOR CT
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-3944
Mailing Address - Country:US
Mailing Address - Phone:714-305-8005
Mailing Address - Fax:
Practice Address - Street 1:5611 WINDSOR CT
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-3944
Practice Address - Country:US
Practice Address - Phone:714-305-8005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver