Provider Demographics
NPI:1538908512
Name:NIEVES, DIANA MARIE (THL)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:MARIE
Last Name:NIEVES
Suffix:
Gender:F
Credentials:THL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1748 BO TABLONAL
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-2439
Mailing Address - Country:US
Mailing Address - Phone:939-323-3796
Mailing Address - Fax:
Practice Address - Street 1:66 CALLE MJ CABRERO
Practice Address - Street 2:
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-4843
Practice Address - Country:US
Practice Address - Phone:787-955-0270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0076062355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty