Provider Demographics
NPI:1538520325
Name:NIEVES-LUCIANO, GIL EDGARDO
Entity type:Individual
Prefix:DR
First Name:GIL
Middle Name:EDGARDO
Last Name:NIEVES-LUCIANO
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:CARR 164 RAMAL 815 KM 3.3
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00719
Mailing Address - Country:UM
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HC 73 BOX 4764
Practice Address - Street 2:
Practice Address - City:NARANJITO
Practice Address - State:PR
Practice Address - Zip Code:00719-9164
Practice Address - Country:US
Practice Address - Phone:787-368-0637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-08
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14037172V00000X
PR21187207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No172V00000XOther Service ProvidersCommunity Health Worker