Provider Demographics
NPI:1548727654
Name:NIEVES VELEZ, MARICELY (LND)
Entity type:Individual
Prefix:MISS
First Name:MARICELY
Middle Name:
Last Name:NIEVES VELEZ
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 CALLE PEDRO HERNANDEZ
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-1915
Mailing Address - Country:US
Mailing Address - Phone:787-364-0741
Mailing Address - Fax:787-262-3984
Practice Address - Street 1:116 AVE DR SUSONI
Practice Address - Street 2:
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659-1847
Practice Address - Country:US
Practice Address - Phone:787-898-4190
Practice Address - Fax:787-262-3984
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2033133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty