Provider Demographics
NPI:1730826389
Name:NIEVES, CLORINDA EILEEN
Entity type:Individual
Prefix:
First Name:CLORINDA
Middle Name:EILEEN
Last Name:NIEVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11650 IBERIA PL STE 130
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2431
Mailing Address - Country:US
Mailing Address - Phone:858-264-5858
Mailing Address - Fax:
Practice Address - Street 1:445 EMERSON ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-2809
Practice Address - Country:US
Practice Address - Phone:619-254-3075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician